Cheating the CHA2DS2-VASc Score: Thromboembolism in Apical Hypertrophic Cardiomyopathy. (20th November 2014)

• Record Type: Journal Article
• Authors: Weir, Robin A. P.; MacKenzie, Nicola; Petrie, Colin J.
• Other Names: Miyasaka Yoko Academic Editor.
• Is Part Of: Case reports in cardiology. Volume 2014(2014)
• Publication Date: 2014-11-20
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1155/2014/189895
• Languages: English
• ISSNs: 2090-6404

Abstract

Abstract : Atrial fibrillation increases the risk of systemic thromboembolism in general and stroke in particular. Not all patients who develop atrial fibrillation are at significantly heightened risk of thromboembolic complications, however, with the development of risk scoring systems aiding clinicians in determining whether formal anticoagulation is mandated. The most commonly used contemporary scoring systems—CHADS2 and CHA2 DS2 -VASc—provide a reliable means of assessing stroke risk, but certain cardiac conditions are associated with an increased incidence of thromboembolism without impacting on these risk scores. Hypertrophic cardiomyopathy, with its apical variant, is such a condition. We present a case of a patient with apical hypertrophic cardiomyopathy and atrial fibrillation who suffered dire thromboembolic consequences despite a reassuringly low CHA2 DS2 -VASc score and suggest that this scoring system is modified to incorporate the thromboembolic risk inherent to certain cardiomyopathies irrespective of impairment of left ventricular systolic dysfunction or clinical heart failure.