Key result
Pharmacological treatment with beta-blockers and calcium channel blockers improved angina symptoms attributed to microvascular ischemia secondary to severe apical hypertrophic cardiomyopathy.
Why the study?
ApHCM is a clinical challenge when presenting with angina and shortness of breath, requiring appropriate diagnosis of concurrent CAD for proper risk stratification and management.
Case Report (n=1)
Multimodality imaging, particularly stress cardiac MRI, is essential for differentiating microvascular ischemia due to apical hypertrophic cardiomyopathy from epicardial coronary artery disease in patients presenting with recurrent angina.
May support medical therapy first after unrevealing angiography in ApHCM angina; leaves open whether CMR-guided care improves outcomes.
Apical hypertrophic cardiomyopathy (ApHCM) is a clinical challenge when presenting with symptoms of angina plus shortness of breath. An appropriate diagnosis of concurrent coronary artery disease (CAD) is needed for proper diagnosis, risk stratification, and management. We present a case of a 64-year-old gentleman with a history of ApHCM and CAD with previous percutaneous intervention presenting with recurrent angina. A repeat coronary angiography showed no new obstructive lesions. A stress cardiac magnetic resonance imaging was performed, which showed perfusion defect in the apex with apical scarring likely secondary to microvascular disease. The patient was managed medically with the improvement of symptoms. Diagnosis and management of CAD in patients with ApHCM are challenging. Multiple diagnostic modalities may be required for delineating the underlying pathology. Patients should be managed initially with medications. If symptoms are not controlled with medical management, a heart team approach with referral to an advanced center experienced in apical myectomy should be considered.
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Mahal et al. (2021) conducted a case report in Apical hypertrophic cardiomyopathy and coronary artery disease (n=1). Beta-blockers and calcium channel blockers was evaluated on Improvement of symptoms. Pharmacological treatment with beta-blockers and calcium channel blockers improved angina symptoms attributed to microvascular ischemia secondary to severe apical hypertrophic cardiomyopathy.
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