pyrophosphate and Cardiomyopathy--Hypertrophic

Topics: Cardiomyopathy, Hypertrophic; Diphosphates; Heart Failure; Humans; Radionuclide Imaging; Technetium

Topics: Cardiomyopathy, Hypertrophic; Diphosphates; Heart Failure; Humans; Radionuclide Imaging; Technetium

Among 144 patients with hypertrophic cardiomyopathy, eight (58.3 +/- 7.0 years, M:F = 7:1) had complicating myocardial infarction, which was diagnosed clinically and by elevated cardiac enzymes or new Q-waves on electrocardiography. Coronary occlusion or stenosis evidenced by coronary angiography and nuclear cardiological findings were investigated. In six of the eight patients, coronary atherosclerosis caused infarction. These patients had many coronary risk factors compared to the other two patients. Sixteen of the 144 patients (11%) with hypertrophic cardiomyopathy had coronary atherosclerosis, the rate of which is reportedly 10 to 20%. Two of the eight patients had no coronary atherosclerosis. One patient had a diffusely spastic diathesis provoked by the intravenous administration of ergonovine maleate during coronary angiography, suggesting that coronary spasm caused myocardial infarction. The other patient had recurrent episodes of supraventricular tachyarrhythmia and no evidence of spasm during coronary angiography, suggesting coronary embolism as a cause of myocardial infarction. Myocardial infarction in patients with hypertrophic cardiomyopathy and normal coronary arteries as advocated by Maron et al. may have such pathogenesis. We conclude that coronary angiography may be mandatory in patients with hypertrophic cardiomyopathy, especially those who have many coronary risk factors and anginal symptoms. In these patients, ST-T changes and abnormal Q-waves on electrocardiography sometimes may be misleading when diagnosing the occurrence of acute myocardial infarction by electrocardiography alone. In such cases, infarct-avid scintigraphy with 99 m-Tc pyrophosphate is preferable.

Topics: Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Diphosphates; Electrocardiography; Embolism; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.

Topics: Amyloidosis; Biopsy; Cardiac Catheterization; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Diphosphates; Echocardiography; Endocardium; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adolescent; Adult; Aged; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Child; Diphosphates; Heart; Humans; Middle Aged; Muscular Dystrophies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate