Coronary Sinus Reducer Improves Myocardial Perfusion in a Patient With Angina, Hypertrophic Cardiomyopathy, and Coronary Microvascular Disease

A 69-year-old woman with incapacitating central chest pain despite 3 antianginal medications at maximum tolerated doses and hypertrophic cardiomyopathy with no evidence of left ventricular outflow tract obstruction but extensive anterior subendocardial perfusion abnormality due to coronary microvascular disease was considered for a coronary sinus reducer to treat refractory angina. History of PresentationWe present the case of a 69-year-old woman with nonobstructive hypertrophic cardiomyopathy (HCM) confirmed on genetic testing, echocardiography, and cardiac magnetic resonance (CMR) imaging and a long history of atypical chest pains who then developed recurrent chest pain at rest radiating to her jaw, with breathlessness, nausea, and palpitations associated with small troponin rises.She was diagnosed with a noneST-segment elevation myocardial infarction complicated by nonsustained ventricular tachycardia.Coronary computed tomographic angiography documented unobstructed coronary arteries, and she was initially treated medically.