Ischemia and atherosclerotic coronary artery disease in patients with hypertrophic cardiomyopathy: A review of incidence, pathophysiological mechanisms, clinical implications and management strategies

Kishore J. Harjai, Jorge Cheirif, Joseph P Murgo

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Ischemia is suspected to occur frequently in patients with HCM and may result from various mechanisms, for example decreased coronary flow reserve, disease of small intramuscular arteries, 'inadequate' size of coronary arteries relative to hypertrophied myocardium, diminution of coronary flow during systole, compression of septal perforator arteries during systole, coronary artery spasm, and co-existent atherosclerotic CAD, which can be present in up to a quarter of HCM patients above 45 years of age. The diagnosis of CAD in patients with HCM is difficult to make on clinical grounds, secondary to the high frequency of angina in patients with HCM without CAD. Pharmacological stress echocardiography is promising but needs to be further studied; stress thallium imaging is beset with frequency false positive results. At this time, coronary angiography remains the only reliable test for the definitive diagnosis of co-existent CAD in HCM. Beta- blockers and verapamil may help in relieving symptoms and silent ischemia in patients with HCM; in those with coexistent CAD and resistant symptoms, CABG alone or in combination with left ventricular myectomy or mitral valve replacement has been recommended.

Original languageEnglish (US)
Pages (from-to)183-187
Number of pages5
JournalCoronary Artery Disease
Volume7
Issue number3
StatePublished - 1996
Externally publishedYes

Fingerprint

Hypertrophic Cardiomyopathy
Coronary Artery Disease
Ischemia
Incidence
Systole
Coronary Vessels
Arteries
Stress Echocardiography
Thallium
Spasm
Verapamil
Coronary Angiography
Mitral Valve
Myocardium
Pharmacology

Keywords

  • atherosclerotic coronary artery disease
  • hypertrophic cardiomyopathy
  • ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8fdc3d04ca04407eaab72960a1a7d60f,
title = "Ischemia and atherosclerotic coronary artery disease in patients with hypertrophic cardiomyopathy: A review of incidence, pathophysiological mechanisms, clinical implications and management strategies",
abstract = "Ischemia is suspected to occur frequently in patients with HCM and may result from various mechanisms, for example decreased coronary flow reserve, disease of small intramuscular arteries, 'inadequate' size of coronary arteries relative to hypertrophied myocardium, diminution of coronary flow during systole, compression of septal perforator arteries during systole, coronary artery spasm, and co-existent atherosclerotic CAD, which can be present in up to a quarter of HCM patients above 45 years of age. The diagnosis of CAD in patients with HCM is difficult to make on clinical grounds, secondary to the high frequency of angina in patients with HCM without CAD. Pharmacological stress echocardiography is promising but needs to be further studied; stress thallium imaging is beset with frequency false positive results. At this time, coronary angiography remains the only reliable test for the definitive diagnosis of co-existent CAD in HCM. Beta- blockers and verapamil may help in relieving symptoms and silent ischemia in patients with HCM; in those with coexistent CAD and resistant symptoms, CABG alone or in combination with left ventricular myectomy or mitral valve replacement has been recommended.",
keywords = "atherosclerotic coronary artery disease, hypertrophic cardiomyopathy, ischemia",
author = "Harjai, {Kishore J.} and Jorge Cheirif and Murgo, {Joseph P}",
year = "1996",
language = "English (US)",
volume = "7",
pages = "183--187",
journal = "Coronary Artery Disease",
issn = "0954-6928",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Ischemia and atherosclerotic coronary artery disease in patients with hypertrophic cardiomyopathy

T2 - A review of incidence, pathophysiological mechanisms, clinical implications and management strategies

AU - Harjai, Kishore J.

AU - Cheirif, Jorge

AU - Murgo, Joseph P

PY - 1996

Y1 - 1996

N2 - Ischemia is suspected to occur frequently in patients with HCM and may result from various mechanisms, for example decreased coronary flow reserve, disease of small intramuscular arteries, 'inadequate' size of coronary arteries relative to hypertrophied myocardium, diminution of coronary flow during systole, compression of septal perforator arteries during systole, coronary artery spasm, and co-existent atherosclerotic CAD, which can be present in up to a quarter of HCM patients above 45 years of age. The diagnosis of CAD in patients with HCM is difficult to make on clinical grounds, secondary to the high frequency of angina in patients with HCM without CAD. Pharmacological stress echocardiography is promising but needs to be further studied; stress thallium imaging is beset with frequency false positive results. At this time, coronary angiography remains the only reliable test for the definitive diagnosis of co-existent CAD in HCM. Beta- blockers and verapamil may help in relieving symptoms and silent ischemia in patients with HCM; in those with coexistent CAD and resistant symptoms, CABG alone or in combination with left ventricular myectomy or mitral valve replacement has been recommended.

AB - Ischemia is suspected to occur frequently in patients with HCM and may result from various mechanisms, for example decreased coronary flow reserve, disease of small intramuscular arteries, 'inadequate' size of coronary arteries relative to hypertrophied myocardium, diminution of coronary flow during systole, compression of septal perforator arteries during systole, coronary artery spasm, and co-existent atherosclerotic CAD, which can be present in up to a quarter of HCM patients above 45 years of age. The diagnosis of CAD in patients with HCM is difficult to make on clinical grounds, secondary to the high frequency of angina in patients with HCM without CAD. Pharmacological stress echocardiography is promising but needs to be further studied; stress thallium imaging is beset with frequency false positive results. At this time, coronary angiography remains the only reliable test for the definitive diagnosis of co-existent CAD in HCM. Beta- blockers and verapamil may help in relieving symptoms and silent ischemia in patients with HCM; in those with coexistent CAD and resistant symptoms, CABG alone or in combination with left ventricular myectomy or mitral valve replacement has been recommended.

KW - atherosclerotic coronary artery disease

KW - hypertrophic cardiomyopathy

KW - ischemia

UR - http://www.scopus.com/inward/record.url?scp=0029906459&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029906459&partnerID=8YFLogxK

M3 - Article

C2 - 8827402

AN - SCOPUS:0029906459

VL - 7

SP - 183

EP - 187

JO - Coronary Artery Disease

JF - Coronary Artery Disease

SN - 0954-6928

IS - 3

ER -