Management of Malignant Arrhythmia in Apical Hypertrophic Cardiomyopathy: A Case Report.

Abstract

BACKGROUND Apical hypertrophic cardiomyopathy (ApHCM) is a rare variant that is less frequently associated with sarcomere mutations and lacks specific diagnosis and risk stratification guidelines. CASE REPORT We present the case of a 41-year-old man with a complex medical history, including type I diabetes mellitus and alcohol use disorder, who presented with nausea and vomiting following alcohol consumption. Initial evaluations revealed significant electrolyte imbalances and non-sustained ventricular tachycardia (NSVT). Echocardiography indicated severe apical hypertrophy consistent with ApHCM. The patient developed polymorphic ventricular tachycardia, which progressed to ventricular fibrillation (VF), necessitating cardiopulmonary resuscitation (CPR) and intensive care. An implantable cardioverter-defibrillator (ICD) was successfully implanted for secondary prevention. CONCLUSIONS This report focuses on the clinical presentation and management of ApHCM, emphasizing the challenges of arrhythmogenic risks and the potential for refractory ventricular arrhythmias. Surgical interventions, such as apical myectomy, can improve functional capacity. This case underscores the critical need for tailored management strategies in patients with ApHCM, particularly in those with substance use disorders, where standard therapies may be contraindicated.