Detection and Clinical Consequences of Myocardial Ischemia and Reduced Coronary Reserve
Chest pain suggestive of reversible myocardial ischemia is a common symptom in patients with hypertrophic cardiomyopathy (HCM) . The ischemie nature of the chest pain, which most often occurs in patients with angiographically normal coronary arteries, could be demonstrated by the presence of reversible perfusion defects on thallium-201 scanning . In addition, net lactate release and a reduced coronary vasodilator reserve during atrial pacing have been reported . The mechanisms of myocardial ischemia in any individual patient with HCM is difficult to determine in vivo, but a number of pathophysiological features, including increased myocardial mass , reduced capillary density  and “small vessel disease ”  may compromise myocardial blood flow sufficiently to cause a mismatch between oxygen supply and demand. HCM is also characterized by abnormalities of left ventricular diastolic function that have the potential to cause myocardial ischemia [7,8].
KeywordsMyocardial Blood Flow Hypertrophic Cardiomyopathy NYHA Class Normal Coronary Artery Hypertensive Heart Disease
Unable to display preview. Download preview PDF.
- 8.Bonow RO, Dilsizian V, Rosing DR, Maron BJ, Bacharach SL, Green MV (1985) Verapamil-induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophie cardiomyopathy: short-and long-term effects. Circulation 72:853–864PubMedCrossRefGoogle Scholar
- 10.Camici PG, Chiriatti G, Lorenzoni R, Bellina CR, Gistri R, Italiani G, Parodi O, Salvadori PA, Nista N, Papi L, L’Abbate A (1991) Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy: a study with nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol 17:879–886PubMedCrossRefGoogle Scholar
- 11.Lorenzoni R, Gistri R, Cecchi F, Chiriatti G, Elliott P, McKenna WJ, Camici PG (1997) The coronary vasodilator reserve is more severely impaired in patients with hypertrophic cardiomyopathy and left ventricular dysfunction. J Am Coll Cardiol 29:462 (abstr)Google Scholar
- 12.Camici PG, Cecchi F, Gistri R, Montereggi A, Salvadori P, Dolara A, L’Abbate A (1991) Dipyridamole-induced subendocardial underperfusion in hypertrophie cardiomyopathy assessed by positron-emission tomography. Coronary Artery Disease 2:837–841Google Scholar
- 14.Choudhury L, Ryan MP, Page CA, Boyd H, Elliott P, McKenna WJ, Camici PG (1994) Does verapamil favourably alter transmural myocardial blood flow distribution in hypertrophie cardiomyopathy? Eur Heart J 15:507 (abstr)Google Scholar