CASE FILES: Apical Hypertrophic Cardiomyopathy

Dr. Gillen and colleagues recently published a case report on a rare type of hypertrophic cardiomyopathy, Yamaguchi variant. Many of us are familiar with hypertrophic cardiomyopathy, which is typically characterized by large voltage ECGs with dagger q waves, but you may not be aware that there are actually multiple subtypes of hypertrophic cardiomyopathy that may also have serious implications and can be more difficult to recognize. Yamaguchi syndrome, is one such subtype that is characterized by apical hypertrophy which can cause deep inverted t waves on ecg.

Abnormal inverted t waves seen in a patient with Yamaguchi syndrome. Source: Gillen J P, Riveros D, Azari L (November 18, 2022) Unusual Cause of a Cardiac Arrest in a Former African American Collegiate Athlete. Cureus 14(11): e31645. doi:10.7759/cureus.31645

The apical variant of hypertrophic cardiomyopathy has a generally better prognosis than obstructive cardiomyopathy, but as demonstrated in this case report, can still lead to arrhythmias and death. The authors of this case, including Dr. Diego Riveros, a sports-medicine fellowship trained emergency physician (and prior graduate of USF EM), advocate that all athletes at every level of competition have cardiac screening performed.

“We propose very strongly that all athletes, whether at junior high school, high school, or collegiate levels, receive an ECG and screening echocardiogram prior to initiation of competition. ”
Cardiology, Team SpotlightUSF Emergency MedicineDr. James Gillen, Dr. Diego Riveros, Cardiology