4 thoughts on “HCM or other ??”

  1. Interesting case, and very similar to one I had a few years ago.
    The arterial intimal proliferation, LV hypertrophy and histological features would fit with cocaine cardiomyopathy. But I suppose to exclude underlying/co-existing HCM requires detailed family hx and ultimately molecular analysis.

    I believe that plucked hair can be useful in assessing long term drug use (and I think Sheffield do this, not sure if they still do?!). If that was indicative of chronic cocaine use, I’d probably go for drug-related aeitiology “on balance”, with a caveat that if there is any significant family history I’d have a low threshold for referral of relatives for screening.

  2. Gross pathological features do raise concerns for hypertrophic cardiomyopathy. However, this is not supported by microscopic examination as shown in the pictures provided. Need to see more sections of the heart. Molecular diagnostics would be helpful too.

  3. The gross morphology raises consideration for hypertrophic cardiomyopathy but the microscopic features do not support.

    I would like to see more sections and look for additional features, eg the narrowing of intramyocardial vessels due to intimal and media hypertrophy, and fine interstitial fibrosis associated with myocardial fibres swirling around. I find these features helpful in support of diagnosis of HCM.

  4. I suspect this is asymmetric cardiac hypertrophy as compensatory effect after cocaine related myocardial ischaemia/ infarction
    but cannot disprove HCM
    if no FH of relevance and given age, I suspect best regarded as drugs death

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