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[Angina pectoris in a hypertensive patient with left ventricle hypertrophy: echo-angiographic comparisons]
Insights
Angina in hypertensive patients may not stem from coronary atherosclerosis. Echocardiography revealed left ventricular hypertrophy in nine patients, suggesting a different cause for their angina symptoms.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Angina pectoris in hypertensive patients is often assumed to be caused by coronary atherosclerosis.
- However, alternative diagnoses should be considered, especially when initial investigations are inconclusive.
Purpose of the Study:
- To investigate the cause of angina pectoris in hypertensive patients with normal coronary arteriograms.
- To evaluate the role of echocardiography in diagnosing cardiac abnormalities in these patients.
Main Methods:
- Nine patients with essential hypertension and severe angina underwent coronary arteriography.
- Ventriculography and echocardiography were performed to assess cardiac structure and function.
- Electrocardiogram (ECG) and chest X-rays were also utilized for comparison.
Main Results:
- Coronary arteriograms were normal in all nine patients, ruling out significant coronary atherosclerosis.
- Ventriculography revealed restrictive or obstructive left ventricular hypertrophy.
- Echocardiography confirmed left ventricular hypertrophy, including septal involvement, and identified ventricular dysfunction in some cases.
- ECG and radiological findings of the heart were largely normal.
Conclusions:
- Angina in some hypertensive patients may result from left ventricular hypertrophy rather than coronary atherosclerosis.
- Echocardiography is a valuable tool for diagnosing cardiac abnormalities in hypertensive patients presenting with angina.
- Beta-blockers may be beneficial in managing such cases.
Abstract:
Not every case of angina pectoris occurring in a hypertensive patient is indicative of coronary atherosclerosis. Nine patients with essential hypertension of moderate degree had attacks of angina of sufficient severity to require investigation by arteriography. In these patients, the coronary arteriogram was normal but ventriculography showed hypertrophy of the walls of the left ventricle of restrictive or obstructive type. These appearances were confirmed by echocardiography which also showed hypertrophy of the septum and, in certain cases, confirmed the involvement of the ventricle, while by contrast the electrocardiogram and radiological appearances of the heart were essentially normal. The beta-blockers may have an important part to play in such conditions, and echocardiography is suggested as part of the routine investigation in cases of hypertension.