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Aging Clinical and Experimental Research

, Volume 29, Issue 2, pp 341–344 | Cite as

Apical aneurysm with thrombus in an elderly patient with hypertrophic obstructive cardiomyopathy

  • Maria Bonou
  • Eva D. PapadimitrakiEmail author
  • Nikolaos Dalianis
  • Nikolaos Alexopoulos
  • Maria Karali
  • Kanella Zerva
  • John Barbetseas
Case Report

Case presentation

A 78-year old woman was admitted for pre-syncope and chest discomfort. She reported dyspnea on exertion for the past 2 months. There was no history of hypertension or familial heart disease and she was not taking any medications.

On admission she had normal saturations at rest and a blood pressure of 100/70 mmHg. Her pulse was 75 bpm and regular. There was a 4/6 diamond shape harsh systolic murmur audible in the left sternal border and on palpation there was left lateral displacement of the point of maximal impulse. Lungs were clear to auscultation and there was no edema.

The electrocardiogram showed sinus rhythm and ST-segment elevation with T-wave inversion in leads V4–V6 (Fig.  1a) whereas troponin I was slightly elevated. Emergent transthoracic echocardiogram revealed a left ventricle (LV) which was severely hypertrophied predominantly at the mid-cavity level, with mid-ventricular obstruction (MVO) manifested by a late peaking pressure gradient of 110 mmHg at...

Keywords

Hypertrophic cardiomyopathy Midventricular obstruction Apical aneurysm Thrombus Elderly 

Notes

Compliance with ethical standards

Conflict of interest

None to declare.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

An informed consent has been obtained by the patient for publication of this case and accompanying images/videos.

Supplementary material

40520_2016_551_MOESM1_ESM.avi (22 mb)
Video S1—Appendix 1. Left ventricular angiogram demonstrating midventicular obliteration at end-systole, along with a large apical aneurysm containing thrombus (AVI 22483 kb)

Video S2—Appendix 2. Contrast echocardiogram showing midventricular hypertrophy, and an hourglass LV shape at systole, with thrombus in an apical aneurysm (WMV 158 kb)

40520_2016_551_MOESM3_ESM.avi (1.1 mb)
Video S3—Appendix 3. Cardiac magnetic resonance imaging demonstrating a spade-shaped LV with midventricular hypertrophy, and an apical aneurysm containing a thrombus in diastole. During systole the left ventricular cavity is obliterated resulting in an hourglass configuration (AVI 1100 kb)

References

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    Olivotto I, Girolami F, Nistri S, et al (2009) The many faces of hypertrophic cardiomyopathy: from developmental biology to clinical practice. J Cardiovasc Transl Res 2:349–367CrossRefPubMedGoogle Scholar
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    Maron MS, Finley JJ, Bos JM et al (2008) Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation 118:1541–1549CrossRefPubMedGoogle Scholar
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    Gupta RM, Weiner RB, Baggish AL et al (2011) Still a kid at heart. Hypertrophic cardiomyopathy in the elderly. Circulation 124:857–863PubMedGoogle Scholar
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    Maron BJ, Rowin EJ, Casey SA et al (2013) Risk stratification and outcome of patients with hypertrophic cardiomyopathy ≥60 years of age. Circulation 127:585–593CrossRefPubMedGoogle Scholar
  5. 5.
    Elliott PM, Anastasakis A, Borger MA et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Maria Bonou
    • 1
  • Eva D. Papadimitraki
    • 1
    Email author
  • Nikolaos Dalianis
    • 1
  • Nikolaos Alexopoulos
    • 2
  • Maria Karali
    • 1
  • Kanella Zerva
    • 1
  • John Barbetseas
    • 1
  1. 1.Department of CardiologyLaiko General HospitalAthensGreece
  2. 2.Cardiology DepartmentAthens EuroclinicAthensGreece

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