Severa compressão sistólica coronariana associada à cardiomiopatia hipertrófica obstrutiva

Cardiomyopathy, hypertrophic; coronary disease.A 65 year old woman with recent onset angina was admitted for acute coronary syndrome without ST elevation. EKG show deep T wave inversion on the anterior and lateral leads.At angiography no coronary stenosis were found, but severe “milking” of the midleft anterior descending coronary artery, up to 100% systolic narrowing was observed (fig. 1, 2, 3 and 4). Intraventricular gradient could be elicited at rest by multipurpose catheter during left ventricle pullback (fig. 5). Two dimensional (cross sectional) echocardiography disclosed asymmetric septal hypertrophy (anterior septum 22 mm, posterior wall 10 mm) with severe and diffuse involvement of the entire interventricular septum and anterolateral wall and left intraventricular gradient at rest was confirmed.