Hypertrophic Obstructive Cardiomyopathy Present as Acute Myocardial Infarction in a Nonagenarian.

BACKGROUND

Hypertrophic obstructive cardiomyopathy (HOCM) may appear as acute myocardial infarction in patients, posing diagnostic challenges.

CASE SUMMARY: A 95-year-old male presented with dizziness, hypotension, and electrocardiogram changes suggesting left main disease, alongside a dynamic rise in cardiac biomarkers. Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR), revealed no functionally significant ischemia. Physical examination showed a systolic murmur, followed by echocardiography, which confirmed HOCM by demonstrating asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, and a left ventricular outflow tract gradient of 40 mm Hg. Management with bisoprolol and mavacamten led to significant symptomatic improvement.

DISCUSSION: This case emphasizes that HOCM may present like acute myocardial infarction. Physical examination and multimodal cardiac imaging are crucial to avoid misdiagnosis.

TAKE-HOME MESSAGES: HOCM is a differential diagnosis for acute coronary syndrome in elderly patients. Cardiac auscultation is crucial in differential diagnosis, combined with multimodal cardiac imaging.