CTICasesMid-Myocardial Variant of Hypertrophic Cardiomyopathy
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Imaging findings
Coronary angiography shows slow flow distally in the coronary arteries, with contrast taking multiple heartbeats to reach the periphery. Echocardiogram shows thickening of the interventricular septum and poor diastolic relaxation. Cardiac MRI reveals thickening of the mid-myocardium of the left ventricle, with obliteration of the cavity, and a relatively thinned apex, characteristic of the mid-myocardial variant of hypertrophic cardiomyopathy.
Key takeaways
Mid-myocardial variant of hypertrophic cardiomyopathy is an uncommon manifestation. It can lead to slow coronary flow, and typically the apical segment may become aneurysmal due to increased pressure. While diastolic dysfunction can occur, it's often less severe than with septal variants. The pattern is distinct from the spade-shaped heart of apical predominant HCM.
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