CMR can uniquely identify the coexistence of hypertrophic cardiomyopathy and ischemic cardiomyopathy caused by coronary vasospasm, which may alter first-line medical therapy to calcium channel blockers.
Hypothesis-generating for coexistent HCM and vasospasm on CMR; leaves open impact on first-line therapy.
We present the case of a 46-year-old male who visited our clinic for the evaluation of ventricular fibrillation and cardiac arrest that occurred one week prior to presentation. He had a family history of hypertrophic cardiomyopathy (HCM). Echocardiography and cardiac magnetic resonance (CMR) imaging revealed myocardial hypertrophy, and he was diagnosed with HCM. Coronary angiography with the ergonovine provocative test showed vasospasm in the proximal left anterior descending artery (LAD), and CMR demonstrated a late-gadolinium enhancement pattern of ischemic cardiomyopathy in the LAD territory and septal HCM. There have been several reports suggesting that coronary spastic angina is not uncommon in Japanese HCM patients, and indicating that calcium channel blockers should be the first-line therapy for variant angina in HCM patients instead of beta-blockers. CMR images displaying the coexistence of HCM and ischemic cardiomyopathy caused by coronary vasospasm have not been previously reported.
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Choi et al. (2018) studied this question.
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