Abstract
We report an unusual case of an elderly woman who presented to the hospital with melena of five-day duration. She has a past medical history of hypertrophic cardiomyopathy diagnosed three years before presentation. She was found to have arteriovenous malformations in the stomach and the duodenum, causing gastrointestinal bleeding. An association between hypertrophic cardiomyopathy and arteriovenous malformations in the gastrointestinal tract was felt likely. The patient was treated with beta-blocker therapy. Later, she was incidentally found to have an anomalous right coronary artery. We discussed potential medical and surgical options, and the patient chose to be treated medically. She was successfully treated with beta-blocker therapy with no further gastrointestinal bleeding. Her clinical course was uncomplicated without cardiac arrhythmia, heart failure, or sudden cardiac death.
Highlights
Sudden cardiac death (SCD) accounts for 300,000 to 400,000 deaths annually in the United States [1]
We present an elderly patient with two common risk factors for SCD, which are hypertrophic cardiomyopathy (HCM) and an anomalous coronary artery
One category of coronary artery anomalies (CAA) is the anomalous origin of the coronary artery from the opposite sinus (ACAOS), anomalies that are recognized as having severe prognostic implications in young individuals
Summary
Sudden cardiac death (SCD) accounts for 300,000 to 400,000 deaths annually in the United States [1]. Knowledge about mechanisms of SCD is increasing, little is known about predicting cardiac events in patients with these underlying these risk factors. We present an elderly patient with two common risk factors for SCD, which are hypertrophic cardiomyopathy (HCM) and an anomalous coronary artery. This association is unusual and was rarely described previously [2]. A 3/6, harsh ejection systolic murmur was best heard in the right upper sternal border She has a history of HCM diagnosed three years prior. The patient was started on metoprolol 100 mg daily with improvement in hemoglobin Four months later, she was seen in the cardiology clinic, and a coronary artery x-ray CT scan (Figure 3) was done to evaluate for coronary artery disease. We are continuing to follow the patient and adjust further management closely
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