MYOCARDIAL INFARCTION WITHOUT OBSTRUCTIVE CORONARY ARTERY DISEASE IN A PATIENT WITH HYPERTROPHIC CARDIOMYOPATHY

Background. Myocardial infarction with non-obstructive coronary arteries is defined by the presence of clinical symptoms and signs of myocardial infarction despite angiographic findings of normal or near-normal coronary arteries. Myocardial infarction with non-obstructive coronary arteries can be classified into myocardial infarction type 1 or type 2. Hypertrophic cardiomyopathy is a possible underlying etiology of myocardial infarction with non-obstructive coronary arteries.

The aim. To present the diagnosis of myocardial infarction in a patient with hypertrophic cardiomyopathy.

Case descriptions. A clinical case of myocardial infarction with non-obstructive coronary arteries in a man with hypertrophic cardiomyopathy is presented. 57-year-old man presented with retrosternal chest pain that appeared at rest but during an attack of tachyarrhythmia. Electrocardiogram showed right bundle branch block and T inversion in the I, avL, V1-V6. Cardiac troponin T was with a rise and fall in the level. Echocardiography demonstrated asymmetrical septal hypertrophy with thickness of the basal and medium segments of the septum 18 mm, systolic anterior motion of the mitral valve, and left ventricular outflow tract obstruction with a peak systolic pressure gradient of 50 mmHg, diastolic dysfunction of the left ventricle. Coronary angiography revealed stenosis of the left anterior descending artery < 50 %. All these data allow us to diagnose the myocardial infarction with non-obstructive coronary arteries.  Type 2 infarction is most likely, however, the absence of an intracoronary imaging does not completely exclude type 1 myocardial infarction.

Conclusion. The clinical case demonstrates myocardial infarction in the absence of obstructive coronary artery disease in patient with hypertrophic cardiomyopathy. To exclude plaque disruption intracoronary imaging should be performed.

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