Left ventricular noncompaction in a patient presenting with a left ventricular failure

Anđelka  Ristić-Andjelkov; Danijela Vraneš; Zorica Mladenović; Siniša Rusović; Nenad Ratković; Snežana Vukotić; Lidija Torbica; Veljko Milić; Tanja Mišić; Mirjana Ristić; Branislav Baškot; Milena Pandrc

doi:10.2298/VSP160124354R

Anđelka Ristić-Andjelkov Military Medical Academy, Clinic for Emergency and Internal Medicine, University of Defence, Medical Faculty, Belgrade, Serbia
Danijela Vraneš Military Medical Academy, Clinic for Emergency and Internal Medicine, University of Defence, Medical Faculty, Belgrade, Serbia
Zorica Mladenović Military Medical Academy, Clinic for Emergency and Internal Medicine, University of Defence, Medical Faculty, Belgrade, Serbia
Siniša Rusović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Nenad Ratković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Emergency and Internal Medicine, Belgrade, Serbia
Snežana Vukotić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Emergency and Internal Medicine, Belgrade, Serbia
Lidija Torbica University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Emergency and Internal Medicine, Belgrade, Serbia
Veljko Milić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Emergency and Internal Medicine, Belgrade, Serbia
Tanja Mišić Military Medical Center „Slavija“, Belgrade, Serbia
Mirjana Ristić Internal Medicine Practice „Nada-a“, Belgrade, Serbia
Branislav Baškot Specialistic Nuclear Medicine Practice „Dr Baškot“
Milena Pandrc Military Medical Center „Slavija“, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160124354R

Keywords: ventricular dysfunction, left;, heart failure;, isolated noncompaction of the ventricular myocardium;, coronary vasospasm; echocardiography;, tomography;, diagnosis, differential.

Abstract

Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG) changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae and sinusoids under the endocardium. The thickness ratio between the two layers was 2.2:1. The same abnormalities were corroborated by multislice computed tomography (MSCT) of the heart. Conclusion. Left ventricular noncompaction is a rare, usually hereditary cardiomyopathy, which should be considered as a possibility in patients with myocardial hypertrophy. It is very often mistaken for coronary disease owing to ECG changes and elevated cardiac specific enzymes associated with myocardial hypertrophy and heart failure.

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