Putilo D.V.1, Stukalova O.V.2, Shalaginova Yu.O.2, Matchina A.Yu.1, Sukhinina T.S.2


1 – I.M. Sechenov First Moscow State Medical University (Sechenov University).

2 – E.I. Chazov National Medical Research Centre of Cardiology, Moscow, Russia.



Purpose. To demonstrate the capabilities of contrast enhanced cardiac MRI in the diagnosis of myo-cardial infarction (MI) in a patient with a combined pathology (obstructive hypertrophic cardiomyopa-thy), using the example of clinical observation.

Materials and methods. A clinical observation of a patient M., 61 years old is presented, who was diagnosed with myocardial infarction on the basis of complaints of pressing chest pains and ECG changes. However, during echocardiography, signs of obstructive hypertrophic cardiomyopathy were revealed for the first time, the areas of local contractility reduction (as signs of acute myocardial in-farction) were not determined. To clarify the changes in the myocardium of the left ventricle, the pa-tient underwent cardiac MRI, the results of which confirmed the presence of acute infarction and clar-ified the degree and form of myocardial hypertrophy. To confirm the diagnosis of hypertrophic cardio-myopathy, a genetic study was performed.

Results. During the ECG, indirect signs of myocardial infarction and signs of combined ventric-ular hypertrophy were revealed, according to echocardiography – there were asymmetrical left ven-tricular myocardial hypertrophy with the development of left ventricular outflow tract obstruction and left ventricular diastolic disfunction. Contrast-enhanced cardiac MRI revealed asymmetric left ven-tricular myocardial hypertrophy, left ventricular outflow tract obstruction, as well as pathological ac-cumulation of gadolinium: characteristic of ischemic lesion (acute myocardium infarction), as well as fibrosis in hypertrophied myocardium. A genetic study revealed mutations confirming hypertrophic cardiomyopathy.

Discussion. Diagnosis of heart diseases, including acute myocardial infarction, against the background of severe myocardial hypertrophy is significantly difficult. In the presented case, classical cardiological diagnostic methods did not allow an accurate diagnosis of acute myocardial infarction.

Conclusion. Cardiac MRI allows to identify violations of the structure of the myocardium, as well as to determine the cause of their occurrence, differentiating ischemic and non-ischemic damage. The diagnostic capabilities of standard diagnostic methods, such as ECG and echocardiography, are inferior to the capabilities of cardiac MRI with delayed contrast when assessing the state of the myo-cardium in difficult situations, especially within a combination of various diseases..


Keywords: cardiac MRI, myocardial infarction, hypertrophic cardiomyopathy.



Corresponding author: Putilo D.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Putilo D.V., Stukalova O.V., Shalaginova Yu.O., Matchina A.Yu., Sukhinina T.S. MRI in diagnosis of acute myocardial infarction in a patient with hypertrophic cardiomyopathy. REJR 2023; 13(1):126-133. DOI: 10.21569/2222-7415-2023-13-1-126-133.



Received: 24.01.23

Accepted: 22.02.23