Many patients with hypertrophic cardiomyopathy experience chest pain, and some of these patients are diagnosed with acute myocardial infarction. Acute myocardial infarction in the setting of hypertrophic cardiomyopathy can occur without coronary atherosclerosis. Although the exact pathophysiologic mechanism of this remains unclear, some pathologic studies have suggested that small vessel coronary artery disease in patients with hypertrophic cardiomyopathy may play a major role in producing myocardial ischemia. Small vessel disease can be suspected when the coronary angiogram shows patent epicardial coronary arteries with slow flow of the angiographic contrast medium. We report here on a case of hypertrophic cardiomyopathy that was complicated with acute myocardial infarction, and this induced catastrophic refractory ventricular tachycardia.
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