isolated nccm was first described in 1984 , but it only regained recognition in the last decade . now , it increasingly attracts scientific attention , especially because the condition has not been fully understood so far and is thus a subject of ongoing investigations on its pathology , development , clinical course , and therapy ( 1 ) . nccm is a primary genetic cardiomyopathy , caused by a defect in endomyocardial morphogenesis . as a result , the muscle of the ventricle is built out of trabeculae with intratrabecular recesses , giving a typical appearance of muscular bands in a spongy mashwork. this specific morphology is reminiscent of the myocardium during early embryogenesis . between the 4th and 18th week of cardiogenesis , a non - compacted structure is essential for the nutrition of the cells , since the muscle is being supplied primarily by diffusion of blood that flows in the intratrabecular spaces . when the angiogenesis of coronary arteries is not accompanied by a simultaneous regression of trabeculae , nccm is occurring ( 2 ) . mostly , they encode for sarcomere and cytoskeleton proteins , such as tafazzin ( taz ) , lim domain binding protein 3 ( ldb3 ) , -dystrobrevin ( dtna ) , lamin a / c ( lmna ) , etc . the exact prevalence is not known and it is assumed to bear a significant number of undiagnosed cases . in echocardiography , it is found in 1 of 2,000 studies . since the diagnosis is defined by structural features , which can only be evaluated by cardiac imaging , mostly transthoracic echocardiography . a diagnosis can be made in the presence of three factors : 1 ) a thickened left ventricular wall consisting of two layers with a maximum ratio of non - compacted to compacted myocardium > 2:1 at end - systole in pax , 2 ) color doppler evidence of flow within the deep intertrabecular recesses , 3 ) prominent trabecular meshwork in the lv apex or midventricular segments of the inferior and lateral wall ( 3 ) . various criteria systems have been described ; however , they all disembogue in the structural features and quantifications . cardiac mri is an advanced option for gaining a closer motion insight of the myocardium . it is especially useful if the morphology is overlapped with other cardiopathies ( 4 ) , due to its enhanced spatial resolution , improved tissue characterization , and lack of ionizing radiation ( 5 ) . the disease may remain silent along the entire life or appear unspecifically , depending to what extent the heart function is affected : dyspnea , fatigue , limbs edema , limited physical capacity , and exercise intolerance . furthermore , tachycardia has recently been found associated with nccm , leading to hypotension . syncopies have not been mentioned so far in possible signs of the disease but are plausible since it is a result of cerebral hypoperfusion . in advanced stages , the prognosis is difficult to predict and has to be individualized , but it can be geared to the resulting cardiac impairment grade . since there is no specific treatment so far , the essential approach is the early recognition of any cardiac dysfunction , prevention of complications and symptom - based therapy , including ace inhibitors , beta - blockers , and aspirin . more aggressive treatments such as surgical interventions have been reported in severe nccm cases ( 6 ) . in our case , the symptoms were still limited to situations where our patient is physically challenged . thus , she was advised to forego intensive sports and advised to have regular check - ups with a cardiologist ( including loop recording and tte ) . patient 's children have been advised to undergo a cardiologic check - up as well . its molecular genetic basis is not yet fully clear , and the same is true of its diagnosis , treatment , and prognosis . the author has not received any funding or benefits from industry or elsewhere to conduct this study .
a 41-year - old female was brought to the er after a presyncope and absence episode while riding a bike . 
 she recalled no prodromi . 
 her physical and neurological examinations were unremarkable ; past medical , family , substance , and travel history bland . she reported a constant tiredness , sporadic slight cephalgia , responsive to acetaminophen , and a recent syncope while jogging , resulting in a fall , circumstances of which she could not recall . 
 non - compaction cardiomyopathy is a type of cardiomyopathy that was first described 25 years ago . 
 its molecular genetic basis is not yet fully clear , and the same is true of its diagnosis , treatment , and prognosis . 
 further study of these matters is needed .