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Impending myocardial infarction in a patient with marked left ventricular hypertrophy and normal coronary
R B Bestetti1, L Z Pinto, L A Finzi
1Department of Pathology, Faculty of Medicine of Ribeirão Preto, São Paulo University, Brazil.
Insights
Impending myocardial infarction can occur in patients with hypertension and left ventricular hypertrophy, even with normal coronary arteries. This case highlights the importance of considering non-coronary causes for heart attack symptoms.
Area of Science:
- Cardiology
- Internal Medicine
- Hypertension Research
Background:
- Long-term uncontrolled arterial hypertension is a significant risk factor for cardiovascular diseases.
- Left ventricular hypertrophy (LVH) is a common adaptation to chronic hypertension, affecting cardiac function.
- Myocardial infarction (MI) is typically associated with coronary artery disease, but other etiologies exist.
Observation:
- A middle-aged woman presented with symptoms suggestive of impending myocardial infarction.
- Coronary arteriogram revealed normal coronary arteries, ruling out significant obstructive coronary artery disease.
- Left heart catheterization and left angiocardiography demonstrated elevated left ventricular end-diastolic pressure and marked left ventricular hypertrophy.
Findings:
- The patient's impending myocardial infarction was secondary to left ventricular hypertrophy caused by arterial hypertension.
- Despite normal coronary arteries, severe cardiac strain was evident from hemodynamic and structural changes.
- Successful treatment was achieved using a combination of beta-blocking and calcium-antagonist agents.
Implications:
- This case underscores that impending myocardial infarction can manifest in patients with hypertensive heart disease, irrespective of coronary artery patency.
- It emphasizes the need for comprehensive cardiac evaluation, including assessment for LVH and diastolic dysfunction, in hypertensive patients presenting with ischemic symptoms.
- The findings support the role of antihypertensive and cardiac-modulating therapies in managing such complex cardiovascular presentations.
Abstract:
A middle-aged woman with long-term uncontrolled arterial hypertension developed a clinical picture of impending myocardial infarction. A normal coronary arteriogram was obtained. However, left heart catheterization showed a marked increase in left ventricular end-diastolic pressure, while left angiocardiography revealed marked left ventricular hypertrophy. She was successfully treated with a beta-blocking and calcium-antagonist agent. The present case shows that an impending myocardial infarction may occur in patients having normal coronary arteriogram but with left ventricular hypertrophy secondary to arterial hypertension.