A Case With Hypertrophic Cardiomyopathy, Whose Chest Symptoms Were Refractory to Medical Therapy

Patients with hypertrophic cardiomyopathy (HCM) frequently have chest symptoms both exercise and rest. We experienced a case of HCM, whose chest symptoms were refractory to medical theraphy. A woman in her forties, came to our institution, because of palpitation and dyspnea at exercise and rest. Echocardiography showed the presence of left ventricular hypertrophy, especially in anterolateral area of left ventricle (LV) and no obvious significant obstruction of LV cavity at rest. She was diagnosed as HCM and took a bisoprolol fumarate with 2.5 mg/day, which was increased to 5 mg/day. However, her symptoms did not respond to the medical therapy. She was admitted to our institution for detail examination of chest symptoms. The right-sided catheterization showed the increased pulmonary capillary wedge pressure with 27 mmHg with normal cardiac output. Coronary angiography showed no significant coronary stenosis. The subsequent spasm provocation test demonstrated diffuse coronary spasm on the left anterior descending coronary artery and left circumflex coronary artery. The assessment of LV pressure did not show significant pressure gradient by a provocation of dobutamine. She was diagnosed as having HCM and vasospastic angina (VSA). Diltiazem as well as bisoprolol were prescribed and her symptoms had been controlled. The cardiologists should keep the presence of VSA as a cause of chest symptoms in HCM in mind.