IJCS | Volume 32, Nº2, May/June 2019

DOI: 10.5935/2359-4802.20190002 293 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(3)293-296 Mailing Address: Erivelton Alessandro do Nascimento Rua Gil Ferreira, 182, Jardim Primavera. Postal Code: 27283-570, Volta Redonda, RJ - Brazil. E-mail: hpcrates7@gmail.com , hpcrates@cardiol.br Isolated Non-Compacted Myocardium: Should We Consider the Presence of Extrasystoles as the Initial Manifestation? Erivelton Alessandro do Nascimento, 1, 2 R aphaella Nagib Carvalho Santos, 3 F ernanda Fraga Tolomelli Dutra, 3 Maria Gabriela Inocente Vitório 3 Centro Universitário de Volta Redonda, 1 Volta Redonda, RJ - Brazil Instituto Estadual de Cardiologia Aloysio de Castro, 2 Rio de Janeiro, RJ - Brazil Hospital Municipal Dr. Munir Rafful, 3 Volta Redonda, RJ - Brazil Manuscript received January 15, 2018; revised manuscript March 4, 2018; accepted March 13, 2018. Heart Failure; Isolated Noncompaction of the Ventricular Myocardium; Arrhythmias, Cardiac; Tachycardia,Ventricular; Diagnostic Imaging. Keywords Abstract Ventricular non-compaction occurs due to failure in myocardial morphogenesis during the fetal period. Patients can have heart failure, as well as systemic complications due to thromboembolism and cardiac arrhythmias. Early diagnosis is essential. We present the case of an asymptomatic 49-year-old woman who initially manifested ventricular extrasystoles and heart failure with reduced ejection fraction and a myocardial noncompaction diagnosis. Introduction The non-compacted myocardium, also known as spongymyocardium, is a distinct formof cardiomyopathy that occurs due to compaction failure during fetal development. It is characterized by prominent ventricular trabeculae and deep intertrabecular recesses, or sinusoids, in communication with the left ventricular cavity. 1-5 It is currently classified as a primary genetic cardiomyopathy by the American Heart Association (AHA) and characterized as an unclassified cardiomyopathy by the World Health Organization (WHO) and the European Society of Cardiology (ESC). 1,4 Theprevalenceof isolatednon-compactedmyocardium in adults remains unclear, 1,3,4,6 although observational studies have found a prevalence of 0.01 to 0.26% in specialized services. 1,2 However, the estimated prevalence may be higher, as asymptomatic individuals rarely undergo imaging studies. 1 In this context, we will address the case of an asymptomatic and previously healthy patient, who had high-incidence ventricular extrasystoles during the preoperative period and anesthesia induction for a cholecystectomy procedure. Case report RASS, a 49-year-old female Caucasian patient, divorced, from Barra do Piraí, state of Rio de Janeiro, Brazil, a caregiver, with a diagnosis of cholelithiasis, had isolated, bigeminy ventricular extrasystoles during the preoperative examinations for a cholecystectomy procedure in August 2013. The procedure was cancelled, and the patient was referred to the cardiology outpatient clinic for assessment. She was asymptomatic and denied previous pathologies and medication use. She also denied smoking and alcohol consumption. She was unaware of heart disease in the family history. On physical examination, the patient had a third sound and frequent extrasystoles. She underwent a 12-lead resting electrocardiogram, which showed ventricular extrasystole and left atrial overload (Figure 1). Chest radiography showed no abnormalities. Subsequently, shewas submittedtoanechocardiogram, which showed Left Atrium (LA) measuring 3.4 cm, Left Ventricular Diastolic Diameter (LVDD) of 6.1 cmand Left Ventricle Systolic Diameter (LVSD) of 4.7 cm; slightly thickened mitral valve; dilated cardiomyopathy with moderate LV systolic dysfunction; and ejection fraction