A rare manifestation of hypertrophic nonobstructive cardiomyopathy in a young patient without history of cardiac arrhythmias

A 25-year-old man presented with atypical thoracal chest pain without typical angina, dyspnoe, syncope or symptomatic cardiac arrhythmias. There was no cardiac risk factors or family history of sudden cardiac death. The ECG (Fig. 1) shows sinus rhythmus, a small Q-wave in V 3-5 but no other abnormalities. All labor parameters including cardiac biomarkers were normal. The transthoracic echocardiography (TTE) was highly suspective of an asymmetric hypertrophy of the lateral left ventricular (LV) wall with normal functional left ventricular parameters without regional wall motion abnormalities. To specify the asymmetric hypertrophy of the LV a cardiac magnetic resonance (CMR) study was performed. Cine-CMR showed a normal size and function of the LV (EDD 146 ml, EDS 37 ml, LV-EF 75%, LV-Cardiac Output 8.6 l/min), but a severe asymmetric hypertropy of the anterolateral left ventricular wall (Figs. 2 and 3) with a maximal diameter of 22 mm and a LV mass of 231 g. There was no morphologic or functional evidence of hypertrophic obstructive cardiomyopathy. Additionally, in contrast-enhanced CMR sequences we found local intramural small areas of delayed enhancement in the hypertrophic left ventricular wall (Fig. 4) [1-3].