Noncompaction cardiomyopathy in an elderly patient: a rare and latediagnosed condition – case report

Abstract

Background. Myocardial noncompaction is a rare congenital cardiomyopathy characterized by an abnormal myocardial structure. It affects the left ventricle or both ventricles. The condition can range from asymptomatic forms to severe clinical manifestations such as heart failure, arrhythmias, and thromboembolic events. Objective(s). Presentation of a clinical case of ventricular noncompaction cardiomyopathy incidentally diagnosed in an elderly patient with severe heart failure and atrial fibrillation. Materials and methods. A 75-year-old male was admitted to the Cardiology Department of SCM “Sfânta Treime.” Clinical and paraclinical data, patient’s medical history were obtained from the medical databases. The patient underwent Investigations: echocardiography, electrocardiography, chest radiography, abdominal ultrasonography, biochemical and hematological analyses. Results. The patient presented with dyspnea on minimal exertion, orthopnea, palpitations, fatigue. Exam: pale-pink skin, moderate peripheral edema, reduced vesicular murmur, irregular heart sounds, systolic murmur at mitral and tricuspid valves, HR 76 bpm, BP 110/60 mmHg. Labs: PT 57%, INR 1.29. Echocardiography: severely reduced left ventricle contractility, noncompaction myocardium, EF 25%, grade III mitral and grade IV tricuspid regurgitation, severe pulmonary hypertension. Chest X-ray showed pleuropneumofibrotic changes, venous congestion, marked cardiomegaly. Treatment included beta-blockers, ACE inhibitors, anticoagulants, and diuretics. Conclusion(s). In the elderly patient, the late diagnosis of noncompaction cardiomyopathy was associated with advanced heart failure and atrial fibrillation, highlighting the need for early recognition of this condition, including the importance of thorough imaging evaluation even at advanced ages.