Never too old for a change

Excerpt

In 2004, a Caucasian 84-year-old female patient with a history of anginal chest pain and palpitations lasting many years was admitted because of increasing general weakness. Twelve-lead electrocardiography (ECG) showed sinus rhythm, ventricular ectopic beats, a positive Sokolow–Lyon index, ST depression, and negative T waves in leads I, II, aVL, and V₃ through V₆ (Fig. 1). Coronary angiography was normal. Echocardiography showed an ejection fraction of 80 %. The left ventricular wall measured 15 mm at its basal portion and increased in thickness toward the apical region. Cardiac magnetic resonance imaging (cMRI) confirmed the diagnosis of asymmetrical apical hypertrophic cardiomyopathy (ahCMP) and showed a small left ventricular apical aneurysm with a wall thickness of only 3 mm (Fig. 2). Subsequently, 24-h ECG monitoring recorded 18,387 monomorphic ventricular ectopic beats, several couplets, 5,302 supraventricular ectopic beats, and 23 supraventricular runs. Because of the clinical symptoms and the documented arrhythmia, a therapy with bisoprolol was initiated, starting with 1.25 mg/b.i.d. Clinical neurologic examination revealed disorientation, bradyphrenia, mild hypomimia, dysarthria, a positive palmomental reflex, positive snout reflex, bilateral ptosis, upward-gaze weakness, bilateral dysmetria, bradykinesia, mild, predominantly distal weakness on the upper limbs and predominantly proximal weakness on the lower limbs, generalized wasting, rigor on the upper limbs, fasciculations, stocking-type sensory disturbances, reduced patella tendon reflexes, absent Achilles tendon reflexes, positive pyramidal signs, contractures of the ankles and ataxic stance, and ataxic, short-stepped gait [1]. …