Reversible cardiac dysfunction in long-standing hypertension may be global variant of stress cardiomyopathy

Abstract

An adult man with long-standing poorly controlled cardiac risk factors presented with acute decompensated heart failure (ADHF). Echocardiogram, cardiac MRI and catheterisation suggested idiopathic dilated cardiomyopathy, severe systolic dysfunction, ejection fraction 25% with global left ventricular (LV) dilation and apical thrombus. He responded well to diuretics and gradual uptitration of lisinopril and carvedilol. Follow-up echocardiogram in 2 months demonstrated complete recovery of systolic function, normalisation of LV size and shape with severe LV hypertrophy. This presentation is potentially a global variant of stress cardiomyopathy with recovery of LV function, highlighting the importance of appropriate imaging, catheterisation and clinical monitoring in patients with ADHF.

Keywords: heart failure; hypertension.

Figure 1

Parasternal long-axis view demonstrating left ventricular (LV) dilatation, moderate LV hypertrophy.

Figure 2

Apical four chamber view demonstrating the 19×7 mm thrombus in the left ventricular apex.

Figure 3

Cardiac MRI demonstrates the distal inferior wall focal transmural infarction and apical thrombus.

Figure 4

Cardiac MRI demonstrates the right ventricular insertion site scar.

Figure 5

Cardiac MRI demonstrates the non-specific mid-lateral wall scar.

Figure 6

Parasternal long-axis view demonstrating normalisation of left ventricular (LV) size, severe LV hypertrophy.