CARDIAC BLUE MOON: A RARE CASE OF LEFT VENTRICLE THROMBUS IN YAMAGUCHI SYNDROME

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Apical hypertrophic cardiomyopathy(ApHCM) is a rare variant of hypertrophic cardiomyopathy. Common presentations include typical or atypical chest pain and tachyarrhythmia. We report a case of wide complex tachycardia secondary to left ventricle(LV) thrombus in ApHCM. CASE PRESENTATION: 53 year old male with past medical history of hypertension and GERD presented with angina and palpitations. Upon arrival he was noted to be in wide complex tachycardia with a rate 230 bpm, he was immediately cardioverted with 200J. Electrocardiogram subsequently showed normal sinus rhythm with T wave inversions in limb leads and strained pattern in V2-V6. Left heart catheterization showed no evidence of coronary ischemia, but ventriculogram showed ‘spade like’ LV cavity concerning for apical hypertrophy. Trans thoracic Echocardiogram (TTE) showed 17 mm left ventricle wall thickness and apical aneurysm. Cardiac MRI was significant for left ventricular wall thickening of 18mm from mid to apical segments with connection to an apical aneurysm. A 2.2 x 1.8cm hypodense mass visualized at the inferior aspect of left ventricular apical aneurysm was confirmed to be a thrombus and he was started on Anticoagulation. Patient underwent successful AICD implantation and was discharged on Sotalol and therapeutic anticoagulation. DISCUSSION: Wide complex tachycardia can have wide ranging etiologies and should not be restricted to ischemia. Physicians must keep a high degree of suspicion for LV thrombus with patients presenting with ApHCM. Implantable defibrillator and antiarrhythmics remain the cornerstone of therapy for ApHCM. Vitamin K antagonist is the mainstay of anticoagulation in this population. CONCLUSIONS: Intra cardiac thrombus, though rare can pose a threat of embolism. Our literature review does show rare cases reported of left ventricle thrombus in apical cardiomyopathy that presented in the form of a tachyarrhythmia. Role of MRI is important in definitively diagnosing a thrombus inside the ventricles and if suspected on Echocardiogram, it should be investigated further with magnetic resonance imagining(MRI) of the heart. Reference #1: Yamaguchi, Hiroshi, et al. "Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients.” The American journal of cardiology 44.3 (1979): 401-412. DISCLOSURES: No relevant relationships by Obaid Ashraf, source=Web Response No relevant relationships by Laila Babar, source=Web Response Speaker/Speaker's Bureau relationship with boehringer ingleheim Please note: $20001 - $100000 Added 03/13/2019 by Tariq Cheema, source=Web Response, value=Honoraria No relevant relationships by Muhammad Asad Faruqi, source=Web Response