open access

Vol 13, No 1 (2018)
Case Reports
Published online: 2018-03-22
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Hypertrophic cardiomyopathy in asymptomatic 24-year-old pregnant woman: management according to ESC guidelines

Robert Morawiec, Anna Cichocka-Radwan, Marek Maciejewski, Urszula Faflik, Małgorzata Lelonek
DOI: 10.5603/FC.2018.0010
·
Folia Cardiologica 2018;13(1):55-58.

open access

Vol 13, No 1 (2018)
Case Reports
Published online: 2018-03-22

Abstract

We present the case of a 24-years old asymptomatic pregnant woman in 18hbd with hypertrophic cardiomyopathy (HCM). An echocardiogram revealed the hypertrophy of all walls of left ventricle (LV), except for the posterolateral wall, from 21mm to 31mm and septal hypertrophy up to 36mm. During the first 48-h-ECG monitoring 5 episodes of slowVT consisted of 3 ExV up to 108/min were recorded. The 5-year HCM SCD (sudden cardiac death) risk score revealed the low risk of 2,25% - implantable cardioverter-defibrylator (ICD) not indicated. After a C-section delivery in 37hbd the control echocardiography revealed the enlargement of LV wall hypertrophy up to 38mm. In 48h-ECG monitoring 2 episodes of asymptomatic nsVT consisted of 4 and 7 ExV up to 162/min were registered. The 5-year HCM SCD risk came up to intermediate level: 5,91% (ICD may be considered, class IIb B of recommendations). Based on the clinical and echocardiographic findings with dynamic progress in the LV hypertrophy, exacerbation of ventricular arrhythmias and increase of NT-proBNP, the ICD was implanted. As presented by Maron & Maron at ESC Congress in London 2015, an MRI scanning with the late gadolinium enhancement (LGE) estimation may be helpful in making the decision on the ICD implantation, especially within the group of the intermediate 5-year risk of SCD (4-6%) with massive LV hypertrophy. Authors suggest the extensive LGE (≥15%) as a primary SCD risk factor and also as a potential risk factor when conventional evaluation of the ICD implantation indications is ambiguous.

Abstract

We present the case of a 24-years old asymptomatic pregnant woman in 18hbd with hypertrophic cardiomyopathy (HCM). An echocardiogram revealed the hypertrophy of all walls of left ventricle (LV), except for the posterolateral wall, from 21mm to 31mm and septal hypertrophy up to 36mm. During the first 48-h-ECG monitoring 5 episodes of slowVT consisted of 3 ExV up to 108/min were recorded. The 5-year HCM SCD (sudden cardiac death) risk score revealed the low risk of 2,25% - implantable cardioverter-defibrylator (ICD) not indicated. After a C-section delivery in 37hbd the control echocardiography revealed the enlargement of LV wall hypertrophy up to 38mm. In 48h-ECG monitoring 2 episodes of asymptomatic nsVT consisted of 4 and 7 ExV up to 162/min were registered. The 5-year HCM SCD risk came up to intermediate level: 5,91% (ICD may be considered, class IIb B of recommendations). Based on the clinical and echocardiographic findings with dynamic progress in the LV hypertrophy, exacerbation of ventricular arrhythmias and increase of NT-proBNP, the ICD was implanted. As presented by Maron & Maron at ESC Congress in London 2015, an MRI scanning with the late gadolinium enhancement (LGE) estimation may be helpful in making the decision on the ICD implantation, especially within the group of the intermediate 5-year risk of SCD (4-6%) with massive LV hypertrophy. Authors suggest the extensive LGE (≥15%) as a primary SCD risk factor and also as a potential risk factor when conventional evaluation of the ICD implantation indications is ambiguous.
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Keywords

hyperthrophic cardiomyopathy, late gadolinium enhancement, ESC guidelines, implantable cardioverter- -defibrillator

About this article
Title

Hypertrophic cardiomyopathy in asymptomatic 24-year-old pregnant woman: management according to ESC guidelines

Journal

Folia Cardiologica

Issue

Vol 13, No 1 (2018)

Pages

55-58

Published online

2018-03-22

DOI

10.5603/FC.2018.0010

Bibliographic record

Folia Cardiologica 2018;13(1):55-58.

Keywords

hyperthrophic cardiomyopathy
late gadolinium enhancement
ESC guidelines
implantable cardioverter- -defibrillator

Authors

Robert Morawiec
Anna Cichocka-Radwan
Marek Maciejewski
Urszula Faflik
Małgorzata Lelonek

References (7)
  1. Elliott PM, Anastasakis A, Borger MA. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(39): 2733–2779.
  2. Maron BJ, Casey SA, Hurrell DG, et al. Relation of left ventricular thickness to age and gender in hypertrophic cardiomyopathy. J Am Cardiol. 2003; 91(10): 1195–1198..
  3. Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000; 102(8): 858–864.
  4. Spirito P, Bellone P, Harris KM, et al. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000; 342(24): 1778–1785.
  5. Elliott PM, Gimeno Blanes JR, Mahon NG, et al. Relation between severity of left-ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet. 2001; 357(9254): 420–424.
  6. Maron MS, Maron BJ. Clinical impact of contemporary cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Circulation. 2015; 132(4): 292–298.
  7. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015; 36(41): 2793–2867.

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