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Two cases of hypertrophic cardiomyopathy with coronary vasospasm
Insights
Chest pain in hypertrophic cardiomyopathy can stem from coronary vasospasm, not just outflow obstruction. Medications like isosorbide dinitrate and calcium antagonists may be more effective than beta-blockers in these specific cases.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Hypertrophic cardiomyopathy (HCM) commonly causes chest pain due to left ventricular outflow tract obstruction and myocardial hypertrophy.
- Standard treatment for chest pain in HCM often involves beta-blockers.
Observation:
- Two cases of HCM presented with chest pain linked to coronary vasospasm.
- Chest pain in these patients did not improve with beta-blockers.
- Symptoms improved with isosorbide dinitrate and a calcium antagonist.
Findings:
- Coronary vasospasm is a potential cause of chest pain in HCM, distinct from outflow obstruction.
- Beta-blockers may exacerbate chest pain in HCM patients with concomitant coronary vasospasm.
- A combination therapy including beta-blockers, isosorbide dinitrate, and calcium antagonists may be required for HCM with variant angina.
Implications:
- This suggests a need to consider coronary vasospasm in HCM patients with refractory chest pain.
- Treatment strategies for chest pain in HCM should be individualized based on the underlying cause.
- Further research is warranted to explore the prevalence and management of variant angina in hypertrophic cardiomyopathy.
Abstract:
Chest pain in patients with hypertrophic cardiomyopathy seems to be caused by relative myocardial ischemia due to the left ventricular outflow pressure gradient and myocardial hypertrophy. However, in 2 cases of hypertrophic cardiomyopathy chest pain was associated with coronary vasospasm. Thus, chest pain in these cases was decreased not by a beta-blocker but by isosorbide dinitrate and a calcium antagonist. Because beta-blockers are commonly used for hypertrophic obstructive cardiomyopathy and chest pain may be aggravated by beta-blockers in patients with coronary vasospasm, a combination of beta-blocker, isosorbide dinitrate and calcium antagonist was necessary for this hypertrophic cardiomyopathy with variant angina.