AI Article Synopsis
- The text discusses a rare case of a 38-year-old female with hypertrophic obstructive cardiomyopathy, experiencing severe angina due to multiple coronary microfistulae and a myocardial bridge.
- Diagnosis was confirmed through various tests, including an electrocardiogram and CT coronary angiography, which revealed specific abnormalities like left ventricular enlargement and a left anterior descending artery myocardial bridge.
- The conclusion highlights that in cases of hypertrophic obstructive cardiomyopathy, angina may result from unusual factors like coronary artery fistulae or myocardial bridges, and CT coronary angiography is recommended for effective screening and treatment planning.
Article Abstract
Background & Objective: Association of multiple coronary arterial microfistulae and myocardial bridge together with concentric diffuse hypertrophic obstructive cardiomyopathy is considerably rare and we aim to highlight a similar unusual but clinically significant association in a young adult female patient with hypertrophic cardiomyopathy, presenting with progressively worsening angina on exertion.
Case Findings: A young 38-year-old female presented to the cardiology clinic of our institute with complaints of angina on exertion New York Heart Association (NYHA) class III for 2 years. An electrocardiogram showed left ventricular enlargement and echocardiography showed diffuse hypertrophic obstructive cardiomyopathy with the systolic anterior motion of the mitral valve and left ventricular outflow tract gradient of 40 mm Hg on Valsalva. CT coronary angiography revealed a diffuse concentric hypertrophic left ventricular myocardium with no regional wall motion abnormality, a mid-left anterior descending artery myocardial bridge, multiple coronary arterial microfistulae from distal left anterior descending (LAD) and right coronary artery (RCA) emptying to the right ventricle and dilated pulmonary artery trunk.
Conclusion: In patients with hypertrophic obstructive cardiomyopathy, angina can be rarely due to coronary artery fistula and or myocardial bridge in addition to myocardial perfusion mismatch owing to hypertrophy or a combination of all. CT coronary angiography seems to be the ideal first noninvasive modality for screening and pre-intervention planning.
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| http://dx.doi.org/10.7417/CT.2024.5140 | DOI Listing |
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