Silent Heart Changes: Late Detection of a Rare Heart Condition

Introduction:

Left ventricular hypertrabeculation, also known as left ventricular non-compaction cardiomyopathy, is a rare myocardial condition characterized by deep trabeculations with implications for cardiac function.

Method:

The aim of this clinical case is to highlight the late diagnosis of left ventricular hypertrabeculation in a patient with non-specific symptoms, emphasizing the importance of continuous monitoring and advanced imaging evaluations for early detection of the disease. The patient, a 47-year-old woman, without any important medical history or cardiac risk factors, presented with fatigue, dyspnea during mild exertion, dizziness, and palpitations. The patient's SCORE2 score was 3.3%.

Results:

After a routine clinical examination, which showed cardiomegaly, the electrocardiogram revealed a rightward electrical axis with frequent ventricular extrasystoles showing severity criteria (R/T phenomena), QRs morphology in V1, V2, and fragmented complexes in aVR. Ventricular monomorphic ectopic beats were frequently recorded on 24-hour ECG Holter monitoring. Suspecting cardiomyopathy, transthoracic echocardiography identified biventricular dilation and visible trabecular formations along the lateral and apical walls, moving synchronously with the myocardium, with blood flow detected in the intratrabecular spaces on Color Doppler, as well as left ventricular systolic dysfunction. The suspicion of left ventricular hypertrabeculation (previously known as non-compaction cardiomyopathy) was confirmed by cardiac magnetic resonance imaging. Under the specific four pillars of heart failure treatment, the evolution was good. In addition, antiarrhythmic treatment with amiodarone was initiated.

Conclusion:

This case underscores the diagnostic challenges posed by left ventricular hypertrabeculation and underscores the value of integrating clinical findings with advanced imaging techniques. Early identification and appropriate management of this rare condition are essential to prevent disease progression and improve patient outcomes.