Nonischemic ST segment elevation in hypertrophic cardiomyopathy due to chest wall deformity from kyphoscoliosis

A 57-year-old male was admitted with suspected acute coronary syndrome. He reported experiencing moderate chest pain when walking during the day prior to admission, but had very prominent ST segment elevations in the precordial electrocardiography (EKG) leads. A physical examination revealed remarka...

Full description

Saved in:
Bibliographic Details
Published in:International medical case reports journal 2010-01, Vol.3 (default), p.43-47
Main Authors: Blinc, Aleš, Gubenšek, Mirjam, Sabovič, Mišo, Grmek, Marko, Berden, Pavel
Format: Article
Language:English
Subjects:
Cardiac patients
Cardiomyopathy
Cardiovascular diseases
Case reports
Chest pain
Coronary heart disease
Diagnostic imaging
Dipyridamole
Electrocardiography
Heart diseases
Hypertrophic cardiomyopathy
Hypertrophy
Ischemia
Medical examination
Myocardial diseases
Myocardial ischemia
Original Research
Perindopril
Troponin
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 57-year-old male was admitted with suspected acute coronary syndrome. He reported experiencing moderate chest pain when walking during the day prior to admission, but had very prominent ST segment elevations in the precordial electrocardiography (EKG) leads. A physical examination revealed remarkable severe kyphoscoliosis with chest deformity. The patient's cardiac troponin levels remained normal, while cardiac ultrasound and magnetic resonance imaging of the chest confirmed hypertrophic cardiomyopathy (HCM) with severe thickening of the interventricular septum. Ischemic heart disease was ruled out by myocardial perfusion imaging with (99m)Tc-MIBI during rest and dipyridamole-induced stress without showing irreversible or reversible myocardial ischemia. Our diagnosis was that the chest pain was noncardiac in origin and that the pronounced ST segment elevations in the precordial EKG leads reflected the severely hypertrophic interventricular septum through the normally thick left ventricular free wall. The patient's chest wall deformity brought his septum and the ventricular free wall nearly parallel to the left side of the chest wall, allowing for complete expression of the reciprocal EKG pattern of septal hypertrophy. We suggest that EKG findings should always be interpreted with the chest wall shape being kept in mind.
ISSN:1179-142X
1179-142X
DOI:10.2147/IMCRJ.S9525