Coronary Steal Phenomenon and Altered Myocardial Microcirculation Demonstrated by Contrast Enhanced Echocardiography in Apical Hypertrophic Cardiomyopathy Presenting as an Acute Coronary Syndrome

Abstract

A 55 year-old female was admitted for central chest pain on a background of hypertension and morbid obesity. 12-lead electrocardiogram revealed sinus rhythm and T-wave inversion inferolaterally. Coronary angiography revealed no significant atherosclerotic epicardial coronary artery disease. Contrast blush was noted in the left ventricular (LV) cavity. Left ventriculography “spade-like” morphology was suggestive of apical hypertrophic cardiomyopathy (ApHCM) (Fig. 1). Cardiac MRI confirmed increased apical wall thickness (17 mm), mid-chamber obliteration during systole and contrast enhancement in thickened apical segments (Fig. 2). Transthoracic echocardiography (TTE) confirmed normal LV size and function (LVEF = 65%) with increased LV apical wall thickness (Fig. 3). Figure 2cMRI. View Large Image Figure Viewer Download Hi-res image Figure 3TTE. View Large Image Figure Viewer Download Hi-res image