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Acute chest pain and massive LV hypertrophy in a 38-year-old man
  1. Vanessa M Ferreira1,
  2. Stefan K Piechnik1,
  3. Soroosh Firoozan2,
  4. Theodoros D Karamitsos1,
  5. Stefan Neubauer1
  1. 1Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Cardiology, Wycombe Hospital, High Wycombe, UK
  1. Correspondence to Dr Vanessa Ferreira, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK; vanessa.ferreira{at}cardiov.ox.ac.uk

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Case—part I

A previously healthy 38-year-old man with no history of cardiovascular disease presented with symptoms of upper respiratory tract infection, acute chest pain, inferior ST-elevation on ECG and a troponin I >60 μg/L (normal <0.04 μg/L). Emergency coronary angiography demonstrated normal coronary arteries. Echocardiogram showed moderate impairment of LV systolic function, inferoposterior wall hypokinesis and severe concentric LV hypertrophy (septum up to 22 mm) with a speckled appearance. A cardiovascular MR (CMR) study was requested to further evaluate the cause of LV hypertrophy (figure 1).

Figure 1

Conventional field strength cardiovascular MR at 1.5 Tesla using tissue characterisation techniques. (From left to right) 4-chamber, 2-chamber, 3-chamber and mid-ventricular short-axis views. T2-weighted (T2W) images detect myocardial oedema when the ratio of myocardial T2 signal intensity compared with skeletal muscle is >2.0; T1-maps display areas of normal left ventricular myocardium (green; normal T1=962±25 ms) and areas with abnormal T1 values by the use of colour scales (red indicates areas with significantly increased T1 >990 ms consistent with oedema). On late gadolinium enhancement (LGE) images, normal myocardium is nulled to black, whereas areas …

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