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Pseudo-normalization of deep T-wave inversions in a patient with apical hypertrophic cardiomyopathy when presenting as apical ballooning syndrome.

Hiten Patel, Rahul Vasudev, Upamanyu Rampal, Paloma Peralta, Arthur Millman

Differential diagnosis of T wave inversions in anterolateral leads includes acute coronary syndrome, intracranial hemorrhage or apical hypertrophic cardiomyopathy (HCM). Later is a rare variant of HCM that usually involves the apex of the left ventricle. Takotsubo cardiomyopathy (TCM) or transient left ventricular (LV) apical ballooning syndrome is a clinical entity mimicking an acute coronary syndrome and characterized by reversible LV dysfunction that is frequently precipitated by a stressful event either emotional or physical stress. We present a case of a 48 year old male with apical HCM that developed TCM causing pseudo-normalization of the baseline T wave inversions. Through this case authors suggest that TCM can cause apical ballooning and can mask the typical ECG changes as seen in patients with apical HCM.