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Reversible ischaemia in hypertrophic cardiomyopathy
H Thomson1, W Fong, W Stafford
1Division of Medicine, Royal Brisbane Hospital, Herston, Queensland, Australia.
Insights
Chest pain in hypertrophic cardiomyopathy (HCM) can stem from ischemia. Dual chamber pacing may alleviate this chest pain by reducing the left ventricular outflow tract gradient and improving cardiac pressures.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Chest pain is a frequent symptom in patients diagnosed with hypertrophic cardiomyopathy (HCM).
- Ischemia is suspected as a cause for chest pain in HCM, but objective demonstration remains challenging.
- Conventional treatments for ischemic chest pain in HCM include beta blockers and calcium blockers, with septal myectomy as a refractory option carrying significant risks.
Observation:
- Dual chamber pacing has emerged as a potential therapeutic strategy for managing refractory symptoms in HCM.
- This intervention is hypothesized to alleviate chest pain through an anti-ischemic mechanism.
- Observed effects include a reduction in the left ventricular outflow tract (LVOT) gradient and a decrease in left ventricular end-diastolic pressure.
Findings:
- Dual chamber pacing may effectively reduce chest pain in a subset of HCM patients.
- The anti-ischemic action is presumed to be linked to the reduction of the LVOT gradient.
- Associated decreases in left ventricular end-diastolic pressure may also contribute to symptom relief.
Implications:
- Dual chamber pacing offers a less invasive alternative to septal myectomy for refractory chest pain in HCM.
- This approach may improve the quality of life for patients with hypertrophic cardiomyopathy.
- Further research is warranted to fully elucidate the mechanisms and long-term efficacy of dual chamber pacing in HCM.
Abstract:
Atypical and typical chest pains are common symptoms in patients with hypertrophic cardiomyopathy. Some of these chest pains seem to be caused by ischaemia. It is difficult to objectively demonstrate ischaemia in hypertrophic cardiomyopathy. The first line treatment for chest pain considered to be ischaemic in patients with hypertrophic cardiomyopathy is the use of either a beta blocker or calcium blocker. Septal myectomy can be effective in patients with symptoms refractory to conventional treatment but is associated with significant morbidity and mortality. Recently dual chamber pacing has been advocated in such patients. In some cases dual chamber pacing alleviates chest pain in hypertrophic cardiomyopathy by an anti-ischaemic action, presumably by reducing the left ventricular outflow tract gradient and perhaps by causing an associated decrease in left ventricular outflow tract gradient and perhaps by causing an associated decrease in left ventricular end diastolic pressure.