Abstract
We report a case of hypertrophic cardiomyopathy diagnosed by endomyocardial biopsy, after cardiopulmonary arrest (CPA) initially suspected to be due to ischemic heart disease. An otherwise healthy 69-year-old male with treated hypertension had sudden CPA while playing tennis. Bystanders started cardiopulmonary resuscitation and performed automated external defibrillator within one minute. The patient was rescucitated and subsequently transferred to the emergency room by ambulance. On arrival, his vital sign were as follows: heart rate, 112 /min; blood pressure, 117/78 mmHg; Japan coma scale II-10. Electrocardiogram showed atrial fibrillation and ST depression in V2-V6. Echocardiography revealed mild diffuse left ventricular hypokinesis. Ischemic heart disease was suspected as the most likely cause of CPA and coronary angiography was performed, on which a 90% stenotic lesion of the middle left anterior descending artery was identified; percutaneous coronary intervention was performed. After intervention, left ventricular wall motion gradually returned to normal on echocardiography, and cardiac enzymes remained within normal limits. This case had some atypical features of ischemic heart disease, and we pursued further examinations including cardiac magnetic resonance imaging and electrophysiology examination, in which extrastimulus examination provoked non-sustained ventricular tachycardia. Subsequent endomyocardial biopsy detected tangled arrangements, and nuclear enlargement and concentration, consistent with hypertrophic cardiomyopathy. A cardiac defibrillator was placed. This case illustrates the importance of thorough investigation for combined heart disease, even when ischemic heart disease is thought to be a primary cause of CPA.
