REVERSIBLE ISCHEMIA IN HYPERTROPHIC CARDIOMYOPATHY

Atypical and typical chest pains are common symptoms in patients with hypertrophic cardiomyopathy. Some of these chest pains seem to be caus ed by ischaemia. It is difficult to objectively demonstrate ischaemia in hypertrophic cardiomyopathy. The first line treatment for chest pai n considered to be ischaemic in patients with hypertrophic cardiomyopa thy is the use of either a beta blocker or calcium blocker. Septal mye ctomy can be effective in patients with symptoms refractory to convent ional treatment but is associated with significant morbidity and morta lity. Recently dual chamber pacing has been advocated in such patients . In some cases dual chamber pacing alleviates chest pain in hypertrop hic cardiomyopathy by an antiischaemic action, presumably by reducing the left ventricular outflow tract gradient and perhaps by causing an associated decrease in left ventricular outflow tract gradient and per haps by causing an associated decrease in left ventricular end diastol ic pressure.