Images in cardiovascular medicine. Coronary artery ectasia and systolic flow cessation in hypertrophic cardiomyopathy.

Abstract

A 24-year-old woman was evaluated for exertional dyspnea and chest pain. Echocardiography showed marked apical, septal (14 mm), and anterolateral (21 mm) hypertrophy with normal inferior and posterior wall thickness (Figure 1⇓). The patient underwent right and left heart catheterization, with coronary and biventricular angiography. The cardiac index was 2.2 L · min−1 · m−2. The left ventricular pressure was 100/0 to 10 mm Hg, without evidence of an intracavitary gradient. Right anterior oblique ventriculography demonstrated a subtotal obliteration of the left ventricular cavity during systole (Figure 2⇓). Simultaneous right and left ventricular angiography revealed a massively thickened interventricular septum (Figure 3⇓). Coronary angiography showed no hemodynamically relevant fixed stenosis. The striking finding was the dilation and pronounced tortuosity of the coronary arteries, particularly the left anterior descending arterial (LAD) system (Figure 4⇓, bottom), without signs of a …