Multiple Rare Causes of Typical Angina Pectoris in a Single Patient

Causas múltiples e infrecuentes de angina de pecho típica en un mismo paciente

Joanna M van de WateraK Gert van HouwelingenaClemens von Birgelena

https://doi.org/10.1016/S1885-5857(07)60132-7

View PDF

Lea este artículo en español

Options

Other articles of interest

Statistics

2407 Total PDF

8499 Total HTML

Year/month	Html	Pdf	Total
2024 October	2	1	3
2024 September	76	16	92
2024 August	56	37	93
2024 July	37	17	54
2024 June	43	15	58
2024 May	55	18	73
2024 April	62	21	83
2024 March	43	17	60
2024 February	38	26	64
2024 January	40	30	70
2023 December	42	22	64
2023 November	44	29	73
2023 October	54	14	68
2023 September	40	16	56
2023 August	19	21	40
2023 July	43	35	78
2023 June	35	11	46
2023 May	52	17	69
2023 April	44	15	59
2023 March	44	16	60
2023 February	30	14	44
2023 January	29	27	56
2022 December	33	26	59
2022 November	49	19	68
2022 October	53	26	79
2022 September	25	46	71
2022 August	32	51	83
2022 July	23	21	44
2022 June	29	20	49
2022 May	28	29	57
2022 April	45	40	85
2022 March	50	45	95
2022 February	57	31	88
2022 January	42	30	72
2021 December	39	32	71
2021 November	56	26	82
2021 October	107	36	143
2021 September	52	22	74
2021 August	51	29	80
2021 July	66	26	92
2021 June	42	27	69
2021 May	63	25	88
2021 April	129	67	196
2021 March	108	33	141
2021 February	105	23	128
2021 January	64	18	82
2020 December	54	25	79
2020 November	36	28	64
2020 October	38	16	54
2020 September	60	9	69
2020 August	83	18	101
2020 July	48	27	75
2020 June	43	15	58
2020 May	53	17	70
2020 April	64	11	75
2020 March	59	12	71
2020 February	38	9	47
2020 January	56	18	74
2019 December	66	30	96
2019 November	49	16	65
2019 October	46	11	57
2019 September	38	16	54
2019 August	34	11	45
2019 July	95	44	139
2019 June	48	32	80
2019 May	34	6	40
2019 April	50	22	72
2019 March	73	13	86
2019 February	78	20	98
2019 January	67	14	81
2018 December	176	17	193
2018 November	61	17	78
2018 October	84	21	105
2018 September	37	8	45
2018 August	45	8	53
2018 July	65	15	80
2018 June	69	9	78
2018 May	52	11	63
2018 April	47	4	51
2018 March	38	5	43
2018 February	42	4	46
2018 January	43	3	46
2017 December	36	4	40
2017 November	30	7	37
2017 October	30	4	34
2017 September	24	8	32
2017 August	27	6	33
2017 July	22	8	30
2017 June	39	10	49
2017 May	42	6	48
2017 April	41	7	48
2017 March	29	2	31
2017 February	66	3	69
2017 January	61	5	66
2016 December	27	8	35
2016 November	48	4	52
2016 October	89	7	96
2016 September	246	9	255
2016 August	58	3	61
2016 July	64	10	74
2016 June	63	14	77
2016 May	53	5	58
2016 April	62	8	70
2016 March	51	7	58
2016 February	64	11	75
2016 January	56	10	66
2015 December	48	5	53
2015 November	57	16	73
2015 October	59	12	71
2015 September	51	21	72
2015 August	68	14	82
2015 July	71	16	87
2015 June	33	6	39
2015 May	39	13	52
2015 April	59	11	70
2015 March	72	11	83
2015 February	59	14	73
2015 January	27	7	34
2014 December	43	5	48
2014 November	32	7	39
2014 October	46	7	53
2014 September	55	5	60
2014 August	36	9	45
2014 July	45	6	51
2014 June	43	12	55
2014 May	35	6	41
2014 April	41	5	46
2014 March	73	10	83
2014 February	45	6	51
2014 January	59	12	71
2013 December	60	14	74
2013 November	48	7	55
2013 October	52	17	69
2013 September	49	16	65
2013 August	60	30	90
2013 July	57	27	84
2013 June	59	47	106
2013 May	64	25	89
2013 April	37	20	57
2013 March	45	16	61
2013 February	31	9	40
2013 January	29	4	33
2012 December	24	14	38
2012 November	21	10	31
2012 October	7	4	11
2012 September	987	0	987

Figure 1.

A 61-year-old Caucasian female presented with exertional chest pain for 3 months, radiating into neck and shoulders. Twenty years ago, she had undergone surgical closure of an atrial septal defect and had been asymptomatic since then. The patient was obese but had no classical risk factor of cardiovascular disease. On physical examination, blood pressure was 134/78 mm Hg with a regular pulse of 95/min, normal heart sounds and a slight systolic murmur.

The electrocardiogram at rest showed sinus rhythm with inverted T-waves in leads I, II, aVL and V2 through V6. Laboratory tests were normal. We performed a single-photon emission computed tomography with dipyridamol during which the patient experienced severe angina while myocardial perfusion imaging revealed no significant abnormality. Considering the known limitations of this technique in obese patients, we then performed coronary angiography. We found no stenosis but both, multiple microfistulae between left anterior descending coronary artery and left ventricle (microfistulae were seen in diastole [A] but not during systole [B]) as well as a large macrofistula between right coronary artery and left ventricle (C, insert). Left ventricular angiography demonstrated the typical pattern of apical hypertrophic cardiomyopathy: a spade-like configuration of the left ventricle (D). The presence of apical hypertrophy was confirmed by transthoracic echocardiography which showed no further abnormality. The patient remained asymptomatic under high-dose a beta-blocker therapy (metoprolol 200 mg/d).

Thus, in this patient the combination of three potential causes of angina pectoris, which are each very rare, was successfully treated by a single and very common drug.