ST-Segment Elevation Myocardial Infarction Presentation in Apical Hypertrophic Cardiomyopathy

Figures

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  Figure 1. ECG at Presentation Electrocardiogram with chest pain (from another center), showing ST-segment elevation in the anterior leads (V1-V4) and diffuse T-wave pseudonormalization that prompted urgent activation of the regional myocardial infarction code.

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  Figure 2. Emergent Coronary Angiography Coronary angiography revealing normal coronary arteries. (A) Left coronary artery. (B) Right coronary artery.

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  Figure 3. Left Ventricular Angiography at Presentation Typical “ace of spades” pattern observed in the left ventricular angiography. AoR = aortic root; LV = left ventricle.

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  Figure 4. ECG Without Chest Pain Electrocardiogram after chest pain resolution, showing the baseline typical pattern of “giant” negative T waves.

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  Figure 5. Cardiac Magnetic Resonance Imaging Cardiac magnetic resonance imaging, unraveling a mixed apical hypertrophic cardiomyopathy, with severe concentric hypertrophy and predominant mid-apical involvement and no evidence of apical aneurysm or late gadolinium enhancement (LGE). Two-chamber (2C) views and short-axis views at the basal, mid-ventricular, and apical segments of the left ventricle on steady-state free-precession (SSFP) cine (A) and LGE sequences (B) are displayed.

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  Figure 6. Exercise Stress Test Electrocardiography (ECG) captured at baseline and during the early recovery phase. The average morphology of the baseline ECG in leads V4-V6 (blue box) is highlighted compared with the corresponding ones during this phase of the test (red box). A clear pseudonormalization of the T waves can be seen.