Why the study?
Can contrast stress echocardiography diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease?
Can contrast stress echocardiography diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease?
Contrast stress echocardiography is a useful imaging modality for diagnosing microvascular myocardial ischemia in patients with severe resistant hypertension and left ventricular hypertrophy without obstructive coronary artery disease.
May aid microvascular ischemia detection by contrast stress echo in resistant hypertension with LVH without CAD; hypothesis-generating, needs prospective validation.
Hypertension is associated with atherosclerosis and cardiac and vascular structural and functional changes. Myocardial ischemia may arise in hypertension independent of coronary artery disease through an interaction between several pathophysiological mechanisms, including left ventricular hypertrophy, increased arterial stiffness and reduced coronary flow reserve associated with microvascular disease and endothelial dysfunction. The present case report demonstrates how contrast stress echocardiography can be used to diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease. The myocardial ischemia was due to severe resistant hypertension complicated with concentric left ventricular hypertrophy and increased arterial stiffness.
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Lønnebakken et al. (2011) studied this question.
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