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Angina pectoris caused by dynamic exercise in hypertrophic cardiomyopathy with normal coronary arteries
H Mori1, T Utsunomiya, C Kawashima
1Third Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Insights
Exertional chest pain in hypertrophic cardiomyopathy (HCM) patients is linked to a rapid heart rate (HR) and left ventricular end-diastolic pressure (LVEDP) increase during early exercise. Gradual hemodynamic changes did not correlate with chest pain occurrence.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a condition affecting the heart muscle.
- Understanding exertional chest pain in HCM patients with normal coronary arteries is crucial.
Purpose of the Study:
- To investigate the relationship between dynamic exercise and the time course of heart rate (HR) and hemodynamics in HCM patients.
- To determine if early or gradual hemodynamic changes correlate with exertional chest pain.
Main Methods:
- 15 patients with HCM and normal epicardial coronary arteries underwent supine ergometer exercise testing during cardiac catheterization.
- Patients were categorized into chest pain (n=6) and no chest pain (n=9) groups.
- Evaluated ST-segment depression, heart rate (HR), and left ventricular end-diastolic pressure (LVEDP) during exercise.
Main Results:
- No significant difference in ST-segment depression was observed between groups.
- A significantly greater increase in HR and LVEDP during the early phase of exercise was noted in the chest pain group compared to the no chest pain group.
- Gradual increases in HR and LVEDP did not show a significant relationship with chest pain.
Conclusions:
- In HCM patients, exertional chest pain is closely associated with a rapid increase in HR and LVEDP during the early stages of dynamic exercise.
- The occurrence of exertional chest pain in HCM is not related to gradual hemodynamic changes during exercise.
Abstract:
To evaluate the relationship between angina pectoris caused by dynamic exercise and the time course of heart rate (HR) and hemodynamics during dynamic exercise in 15 patients with hypertrophic cardiomyopathy (HCM) with normal epicardial coronary arteries, the supine ergometer exercise test was performed during cardiac catheterization. The HCM patients were divided into a chest pain group (n = 6) and a no chest pain group (n = 9) based upon the results of the ergometer exercise test. There was no significant difference in the level of ST-segment depression after exercise in both the chest pain and no chest pain groups (-2.1 +/- 0.6 mm vs -2.6 +/- 1.1 mm, NS). Increase in heart rate (HR) and left ventricular end-diastolic pressure (LVEDP) in the early phase of the exercise test was significantly greater in the chest pain group compared with the no chest pain group. These observations suggest that in HCM patients, the occurrence of exertional chest pain has a close relationship with the rapid increase in HR and LVEDP in the early phase of dynamic exercise, but does not have a relationship with the gradual increase in these parameters.