A Case of Hypertrophic Obstructive Cardiomyopathy and Vasospastic Angina, in Which Controlling Medical Treatment was in Great Distress

Abstract

Vasospastic angina (VSA) is accompanied with hypertrophic obstructive cardiomyopathy (HOCM). In such patients, controlling medical treatment may be sometimes difficult, because some drugs for VSA may deteriorate the status of HOCM. We experience such case. A woman in her seventies, was admitted to our institution, because of detail examination of chest symptoms at rest. Coronary angiography showed the presence of coronary spasm. In addition, cardiac catheterization showed that the positive Brochenbrough phenomenon. This patient was diagnosed as having HOCM and VSA. Diltiazem was prescribed and she had been followed by her family doctor. Two years later, she could not walk for a short distance and was admitted to our institution. At admission, she took some medications, such as diltiazem, telmisartan and diuretics. Blood chemical data showed the elevation of BNP (769 pg/mL). Echocardiography (UCG) showed the significant pressure gradient through left ventricle outflow tract (LVOT, 159 mmHg) at rest. We judged the worsening status of HOCM and prescribed cibenzoline with 150 mg, but pressure gradient did not changed. We stopped the diuretics and changed from diltiazem to verapamil. Thereafter, her symptoms improved and the pressure gradient though LVOT reduced and she was discharged. Several cardiovascular medications may affect the status of HOCM and the cardiologists should be careful in selection of such drugs in patients with HOCM.