Myocardial injury mimicking acute myocardial infarction due to coronavirus infection in adults with pre-existing apical hypertrophic cardiomyopathy

Abstract

Symptoms of apical hypertrophic cardiomyopathy
(ApHCM) can mimic acute myocardial infarction (AMI).
Following COVID-19 infection, the elevation of troponin
in ApHCM might be confusing, due to its similarity with
AMI. We report the case of a 64-year-old male patient
presenting with exertional dyspnoea and chest
discomfort. He had no history of coronary artery disease
(CAD), but his swab test was positive for COVID-19. The
physical examination was normal. The 12-lead
electrocardiogram showed a sinus rhythm of 78 bpm,
with deep inverted T waves in leads V2 to V6, I, and aVL,
and left ventricular hypertrophy. An Echocardiographic
examination showed an 18 mm apical wall thickness of
the left ventricle. Laboratory tests revealed elevated hs-
Troponin level, but diagnostic coronary angiography was
normal. The diagnostic criteria fulfilled apical cardiac
hypertrophic cardiomyopathy. Coronavirus can induce
atypical cardiovascular symptoms in pre-existing ApHCM.
Misdiagnosis and failure to recognize may result in
inappropriate therapy and delay in definitive treatment.
Keywords: Troponin, COVID-19, Echocardiography,
Electrocardiography, Hypertrophy, Angiography,
Dyspnea, Infarction