[SCD-FORUM] 87E RE: Alleged apical hypertrophic cardiomyopathy. Dr. Jamil

[SCD INFO]

Dear Luis Wolman

Thank you very much for presenting such an interesting case history. 
Apical hypertrophic cardiomyopathy relatively common in Asia including 
Bangladesh. Regarding management of your patient, he doesn't require any 
active treatment at present. But as his father died suddenly in 
premature age, he needs farther evaluation to detect potential risk of 
malignant vetricular arrhythmia and SCD. So, EPS would be a good choice 
for farther evalation and to decide for profilactic ICD for prevention 
of SCD. Thank you very much.

Abdullah Al Jamil, MBBS, FCPS, MD
Electrophysiologist
Associate Professor of Cardiology
Bangabandhu Sheikh Mujib Medical University
Shabag, Dhaka-1000, Bangladesh

> Hello, friends from the cyberspace,
> Congratulations and thank you for this new great event. I would like 
> to ask about the best management to follow in the following clinical 
> case: this is a 56-year-old patient, who consulted 10 years ago as a 
> routine. In that moment he had a very pathological ECG, with negative 
> and huge T waves in all the anterior side. We conducted ergometer 
> test, 2D echo, Holter and coronary angiography, and all of them 
> resulted normal. Since then studies have been repeated annually, and 
> he remains completely asymptomatic. The ECG persists with no changes 
> and the two last echoes report: apical ventricular hypertrophy. A 
> spect gamma camera does not report the alleged apical hypertrophy. We 
> have scheduled a cardiac resonance. The question is: should this 
> patient receive any treatment? For instance, beta blockers?
> At first I had thought that this was a case of genetic hypertrophic 
> cardiomyopathy (troponin?) without phenotype. Now, I'm not sure that's 
> correct. I would like to have your opinion about what management to 
> follow. The father of the patient died when he was 56 years old, 
> suddenly, but he ignores if the father was a coronary patient, and the 
> sons of the patient do not show any pathology to this date. Thank you 
> very much,
> Luis Wolman