JACC Case Rep. 2026 Jul 29;31(30):108605. doi: 10.1016/j.jaccas.2026.108605.
ABSTRACT
BACKGROUND: ST-segment elevation on electrocardiography is classically associated with acute transmural myocardial ischemia due to coronary artery occlusion and is central to the diagnosis of ST-segment elevation myocardial infarction. However, persistent ST-segment elevation may also reflect nonischemic structural heart disease.
CASE SUMMARY: A 62-year-old woman presented with chest pain and widespread ST-segment elevation with T-wave inversion. Coronary angiography showed no obstructive disease. Echocardiography and cardiac magnetic resonance revealed midventricular hypertrophic cardiomyopathy with systolic midcavity obstruction and a left ventricular apical aneurysm. Nonsustained ventricular tachycardia was documented, and an implantable cardioverter-defibrillator was placed for primary prevention.
DISCUSSION: This case illustrates a rare, high-risk hypertrophic cardiomyopathy phenotype in which persistent ST-segment elevation mimics acute myocardial infarction.
TAKE-HOME MESSAGES: Midventricular hypertrophic cardiomyopathy with apical aneurysm can present with persistent ST-segment elevation and T-wave inversion, mimicking myocardial infarction. Electrocardiography is a valuable diagnostic and surveillance tool in this phenotype, as characteristic ST-segment abnormalities may precede or complement imaging findings.
PMID:42530185 | PMC:PMC13420568 | DOI:10.1016/j.jaccas.2026.108605