Idiopathic Hypertrophic Subaortic Stenosis and Associated Coronary Artery Disease

Bensaid, Julien
September 1979
Angiology;Sep1979, Vol. 30 Issue 9, p585
Academic Journal
The features of coexisting idiopathic hypertrophic subaortic stenosis and coronary artery disease have been analyzed through a review of 57 cases from the literature. The association of the two diseases was seen mainly in men with a mean age of 56 years. The clinical features were disabling angina pectoris in 93% exertional dyspnea in 71%, and syncope or lipothymia in 48%. Electrocardiograms showed left ventricular hypertrophy in 61% and abnormal Q waves in 27%. It seemed difficult or even impossible to suspect coexisting CAD in patients with IHSS based on clinical or electrocardiographic features. The analysis of hemodynamic data has shown a left ventricular outflow tract gradient at rest in only 50%, with a mean gradient value of 51 mm Hg. Mitral regurgitation was associated to the IHSS in 60% Coronary arteriography has shown significant atheromatous coronary disease in one vessel in 61.5%, in two vessels in 27%, and in three vessels in 11.5%. It seems a good rule to perform a coronary angiography to detect CAD in patients with IHSS and disabling angina pectoris in spite of adequate beta blockade therapy, mainly in patients over the age of 45, if coronary risk factors are present and/or if the left ventricular outflow tract gradient is low at rest (< 50 mm Hg). Likewise, it seems a good rule lo look for coexisting IHSS in the patients with well-documented CAD by means of noninvasive techniques such as phonocardiography and echocardiography. The first-line treatment of coexisting IHSS and CAD is beta-blockade therapy. If there is no improvement with medical therapy or if the drugs induce intolerable side effects, surgery is indicated. The best procedure is simultaneous myectomy and coronary artery bypass.


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