A middle-aged woman with long-term uncontrolled arterial hypertension de veloped a clinical picture of impending myocardial infarction. A normal coro nary arteriogram was obtained. However, left heart catheterization showed a marked increase in left ventricular end-diastolic pressure, while left angiocardi ography revealed marked left ventricular hypertrophy. She was successfully treated with a beta-blocking and calcium-antagonist agent. The present case shows that an impending myocardial infarction may occur in patients having normal coronary arteriogram but with left ventricular hypertrophy secondary to arterial hypertension.
Get full access to this article
View all access options for this article.
References
1.
Haines DE, Raabe DS, Gundel WD, et al: Anatomic and prognostic significance of new T-wave inversion in unstable angina. Am J Cardiol52:14-18, 1983.
2.
Zwaan C, BarFWHM, Wellens HJJ: Characteristic electrocardiographic pattern indicating a critical stenosis high in the left anterior descending coronary artery in patients admitted because of impending myocardial infarction . Am Heart J103:730-736, 1982.
3.
Bestetti RB, Finzi LA, Amaral Ftv, et al: Myocardial bridging of coronary arteries associated with an impending acute myocardial infarction. Clin Cardiol10:129-131, 1987.
4.
Bestetti RB, Finzi LA, Oliveira Jsm: Chronic Chagas' heart disease presenting as an impending myocardial infarction: A case favoring the neurogenic pathogenesis concept. Clin Cardiol10:368-370, 1987.
5.
Opherk D., Mall G., Zebe H., et al: Reduction of coronary reserve: A mechanism of angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation69:1-7, 1984.
6.
Selzer A., Lagston M., Ruggeroli C., et al: Clinical syndrome of variant angina with normal coronary arteriogram . N Engl J Med295:1343-1348, 1976 .
7.
Miklozek CL, Crumpacker CJ, Royal HD, et al: Myocarditis presenting as acute myocardial infarction. Am Heart J115:768-776, 1988.
8.
Stratmann HG : Acute myocarditis versus myocardial infarction: Evaluation and management of the young patient with prolonged chest pain—case report. Angiology39:253-258, 1988.
9.
Bush CA, Fanning W., Kolibash AH, et al: Elevated left ventricular filling pressure as a cause of angina in patients with normal coronary arteries. Am J Cardiol (abstract)49:950, 1982.
10.
Cannon RO, Rosing DR, Maron BJ, et al: Myocardial ischemia in patients with hypertrophic cardiomyopathy: Contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation71:234-243, 1985.
11.
Strauer B-E. : Ventricular function and coronary hemodynamics in hypertensive heart disease. Am J Cardiol44:999-1006, 1979.
12.
Marcus ML, Harrison DG, Chilian WM, et al: Alterations in the coronary circulation in hypertrophied ventricles . Circulation75:119-125, 1987.
13.
Hoffman Jie : A critical view of coronary reserve. Circulation75:16-111, 1987.
14.
Neil WA, Lundeen Jhf: Myocardial oxygen supply in left ventricular hypertrophy and coronary heart disease. Am J Cardiol44:747-753, 1979.
