2017 Volume 37 Issue 2 Pages 63-70
A 71 year-old woman was admitted to our hospital because of chest pain. She had been suffering from diabetes mellitus since age 30. Electrocardiography and echocardiography showed left ventricular hypertrophy. Coronary angiography showed significant stenosis at the left anterior descending artery, and we performed percutaneous coronary intervention successfully. We diagnosed her case as familial hypertrophic cardiomyopathy with angina pectoris because she has had many relatives with heart disease, though not diabetes nor deafness. After 8 years, her electrocardiography changed gradually and drastically, becoming precordial lead to QS pattern, and she also had mild deafness, suggesting mitochondrial disease. We investigated mitochondrial 3243 mutation and found two percentage heteroplasmy. Combined with cardiac magnetic resonance imaging that showed extensive myocardial defect, we confirmed the diagnosis of her disease as mitochondrial cardiomyopathy. We speculated her angina not only representing diabetic atherosclerosis but also implicating vascular smooth muscle dysfunction due to mitochondrial disease. Precordial QS pattern may suggest a diagnosis of mitochondrial cardiomyopathy.
