Skip to main content
SpringerLink
Log in

Myocardial Ischemia in Hypertrophic Cardiomyopathy: Clinical Assessment and Role in Natural History

  • Chapter
Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

  • 112 Accesses

Abstract

The cardiomyopathies are a group of primary heart muscle diseases, classified into hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular forms according to specific morphological and physiological criteria. The pathophysiology of all cardiomyopathies is complex and remains incompletely understood, but myocardial ischemia is thought to play a role in the natural history of several types of cardiomyopathy, in particular the hypertrophic form. This chapter reviews the evidence for impaired myocardial blood flow in patients with hypertrophic cardiomyopathy and briefly discusses its potential role in the pathophysiology of this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Spirito P, Seidman CE, McKenna WJ, Maron BJ. The management of hypertrophic cardiomyopathy. N Engl J Med 1997;336:775–785.

    Article  PubMed  CAS  Google Scholar 

  2. Report of the 1995 World Health Organization/International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation 1996;93:841–2.

    Article  Google Scholar 

  3. Kimura A, Harada H, Park J-E et al. Mutations in the cardiac troponin I gene associated with hypertrophie cardiomyopathy. Nature Genetics 1997;16:379–382.

    Article  PubMed  CAS  Google Scholar 

  4. Watkins H, Thierfelder L, Hwang D, McKenna WJ, Seidman JG, Seidman CE. Sporadic hypertrophic cardiomyopathy due to de novo myosin mutations. J Clin Invest 1992;90:1666–71.

    Article  PubMed  CAS  Google Scholar 

  5. Frank S, Braunwald E. Idiopathic hypertrophic subaortic stenosis: clinical analysis of 126 patients with emphasis on the natural history, Circulation 1968;37:759–88.

    Article  PubMed  CAS  Google Scholar 

  6. McKenna WJ, Deanfield J, Faruqui A, England D, Oakley C and Goodwin J. Prognosis in hypertrophic cardiomyopathy. Role of age and clinical, electrocardiographic and hemodynamic features. Am J Cardiol 1981; 47: 532–8.

    Article  PubMed  CAS  Google Scholar 

  7. Wigle ED, Sasson Z, Henderson MA, Ruddy TD, Fulop J, Rakowski H, Williams WG. Hypertrophic cardiomyopathy: the importance of the site and extent of hypertrophy: a review. Prog Cardiovasc Dis 1985;28:1–83.

    Article  PubMed  CAS  Google Scholar 

  8. Gilligan DM, Chan WL, Ang EL, Oakley CM. Effects of a meal on hemodynamic function at rest and during exercise in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1991;18:429–36.

    Article  PubMed  CAS  Google Scholar 

  9. O’Gorman DJ, Sheridan DJ Abnormalities of the coronary circulation associated with left ventricular hypertrophy. Clin Sci 1991;81:703–13.

    PubMed  Google Scholar 

  10. Scheler S, Motz W, Strauer BE. Transient myocardial ischemia in hypertensives: the missing link with left ventricular hypertrophy. Eur Heart J 1992;13 (suppl D):62–65.

    Article  PubMed  Google Scholar 

  11. Tomanek RJ, Palmer RJ, Pfeiffer GL, Schreiber KL, Eastham CL, Marcus ML Morphometry of canine coronary arteries, arterioles and capillaries during hypertension and left ventricular hypertrophy. Cire Res 1986;58:38–46.

    Article  CAS  Google Scholar 

  12. Davies MJ, McKenna WJ. Hypertrophic cardiomyopathy: pathology and pathogenesis. Histopathology 1995;26:493–500.

    Article  PubMed  CAS  Google Scholar 

  13. Maron BJ, Wolfson JK, Epstein SE, Roberts WC. Intramural (“small vessel”) coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol 1986; 8:545.

    Article  PubMed  CAS  Google Scholar 

  14. Tanaka M, Fujiwara H, Onodera T, Wu D, Matsuda M, Hamashima Y, Kawai C. Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts, and hearts with hypertrophie cardiomyopathy. Circulation 1987; 75: 1130–9.

    Article  PubMed  CAS  Google Scholar 

  15. Pichard AD, Mellor J, Teichholz LE, Lipnik S, Gorlin R, Herman MV. Septal perforation compression (narrowing) in idiopathic hypertrophic subaortic stenosis. Am J Cardiol 1977;40:310–4.

    Article  PubMed  CAS  Google Scholar 

  16. Brugada P, Bar FW, de Zwaan C, Green M, Wellens HJ. “Sawfish” systolic narrowing of the left anterior descending artery: an angiographic sign of hypertrophic cardiomyopathy. Circulation 1982;66:800–3.

    Article  PubMed  CAS  Google Scholar 

  17. Akasaka T, Yoshikawa J, Yoshida K, Maeda K, Takagi T, Miyake S. Phasic coronary flow characteristics in patients with hypertrophic cardiomyopathy: a study by coronary doppler catheter. J Am Soc of Echocardiography 1994;7:9–19.

    CAS  Google Scholar 

  18. Cannon RO, Dilsizian V, O’Gara P, Udelson JE, Schenke WH, Quyyumi A, Fananapazir L, Bonow RO. Myocardial metabolic, hemodynamic, and electrocardiographic significance of reversible thallium-201 abnormalities in hypertrophic cardiomyopathy. Circulation 1991;83:1660–67.

    Article  PubMed  Google Scholar 

  19. Elliott PM, Kaski JC, Prasad K, Seo H, Slade AK, Goldman JH, McKenna W.I. Chest pain during daily life in patients with hypertrophic cardiomyopathy: an ambulatory electrocardiographic study. Eur Heart J 1996;17:1056–1064.

    Article  PubMed  CAS  Google Scholar 

  20. Pastemac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG. Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteriograms. Circulation 1982; 65:778.

    Article  Google Scholar 

  21. Nicod P, Polikar R, Peterson KL. Hypertrophic cardiomyopathy and sudden death. N Engl J Med 1988; 318: 1255–7.

    Article  PubMed  CAS  Google Scholar 

  22. Camici P, Chiriatti G, Lorenzoni R, Bettina RC, Gistri R, Italiani G, Parodi O, Salvadori PA, Nista N, Papi L, L’Abbate A. Coronary vasodilatation is impaired in both hypertrophied and non hypertrophied myocardium of patients with hypertrophic cardiomyopathy: A study with Nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol 1991;17:879–86.

    Article  PubMed  CAS  Google Scholar 

  23. Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson MD, Epstein SE. Myocardial ischemia in patients with hypertrophie cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation 1985;71:234–437.

    Article  PubMed  Google Scholar 

  24. O’Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE. Myocardial perfusion abnormalities in patients with hypertrophie cardiomyopathy: Assessment with thallium-201 emission computed tomography. Circulation 1987;76:1214–23.

    Article  PubMed  Google Scholar 

  25. Yamada M, Elliott PM, Gane J, Britten A, Kaski JC, McKenna WJ. Relation of thallium-201 perfusion abnormalities to clinical and prognostic markers in hypertrophic cardiomyopathy. Eur Heart J 1998;19: (in press).

    Google Scholar 

  26. Pitcher D, Wainwright R, Maisey M, Curry P, Sowton E. Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy. Br Heart J 1980;44:650–6.

    Article  PubMed  CAS  Google Scholar 

  27. Rubin KA, Morrison J, Padnick MB, Binder AJ, Chiaramida S, Margouleff D, Padmanabhan VT, Gulotta SJ. Idiopathic Hypertrophic Subaortic Stenosis: Evaluation of anginal symptoms with Thallium-201 Myocardial imaging. Am J Cardiol 1979; 44: 1040–45.

    Article  PubMed  CAS  Google Scholar 

  28. Von Dohlen TW, Prisant LM, Frank MJ. Significance of positive or negative thallium-201 scintigraphy in hypertrophic cardiomyopathy. Am J Cardiol 1989;64:498–503.

    Article  Google Scholar 

  29. Maddahi J, Abdulla A, Garia EV, Swan HJC, Berman DS. Noninvasive identification of left main and triple vessel coronary artery disease: Improved accuracy using quantitative analysis of regional myocardial stress distribution and washout of thallium-201. J Am Coll Cardiol 1986;7:53–56.

    Article  PubMed  CAS  Google Scholar 

  30. Camici P, Cecchi F, Gistri R, Montereggi A, Salvadori PA, Dolara A, L’Abbate A. Dipyridamoleinduced subendocardial underperfusion in hypertrophic cardiomyopathy assessed by positron-emission tomography. Coronary Artery Disease 1991;2:837–41.

    Google Scholar 

  31. Nienaber CA, Gambhir SS, Mody FV et al. Regional myocardial blood flow and glucose utilization in symptomatic patients with hypertrophie cardiomyopathy. Circulation 1993;87:1580–90.

    Article  PubMed  CAS  Google Scholar 

  32. Grover-McKay M, Schwaiger M, Krivokapich J, Perloff JK, Phelps ME, Schelbert HR. Regional myocardial blood flow and metabolism at rest in mildly symptomatic patients with hypertrophie cardiomyopathy. J Am Coll Cardiol 1989;13:317–24.

    Article  PubMed  CAS  Google Scholar 

  33. Camici P, Marraccini P, Lorenzoni R et al. Metabolic markers of stress-induced myocardial ischemia. Circulation 1991; 83(5 Suppl):III8–13.

    PubMed  CAS  Google Scholar 

  34. Gertz EW, Wisneski JA, Neese R, Houser A, Korte R, Bristow JD. Myocardial lactate extraction: multi-determined metabolic function. Circulation 1980;61:256–6.

    Article  PubMed  CAS  Google Scholar 

  35. Crake T, Crean PA, Shapiro LM, Rickards AF, Poole-Wilson PA. Coronary sinus pH during percutaneous transluminal angioplasty: early development of acidosis during myocardial ischemia in man. Br Heart J 1987;58:110–15.

    Article  PubMed  CAS  Google Scholar 

  36. Cobbe S. M., Poole-Wilson P.A. Continuous coronary sinus and arterial pH monitoring during pacing induced ischemia in coronary artery disease. Br Heart J 1982;47:369–74.

    Article  PubMed  CAS  Google Scholar 

  37. Elliott PM, Rosano GMC, Gill JS, Poole-Wilson PA, Kaski JC, McKenna WJ. Changes in coronary sinus pH during dipyridamole stress in patients with hypertrophie cardiomyopathy. Heart 1996;75:179–183.

    Article  PubMed  CAS  Google Scholar 

  38. Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophie cardiomyopathy. J Am Coll Cardiol 1993;22:796–804.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Perry M. Elliott
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. St George’s Hospital Medical School, London, UK

    Juan Carlos Kaski MD, MRCP, FACC, FESC (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group) (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group)

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Elliott, P.M. (1999). Myocardial Ischemia in Hypertrophic Cardiomyopathy: Clinical Assessment and Role in Natural History. In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_27

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_27

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7360-5

  • Online ISBN: 978-1-4615-5181-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation