Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy that is diverse in clinical presentation, morphology, and natural progression. Chest pain in patients with HCM requires an accurate evaluation, especially in relation to the degree of left ventricular outflow tract (LVOT) obstruction. We report a case of HCM who was admitted to the hospital in the setting of left-sided chest pain with elevated hypersensitive cardiac troponin, but resting echocardiography showed only mild LVOT obstruction. Whether the myocardial damage in this patient is due to an elevated LVOT pressure gradient during exercise, coronary artery disease, or ventricular arrhythmias that cause myocardial oxygen demand-supply imbalance. The patient underwent coronary CT angiography, cardiac MRI, and 24-hour holter electrocardiogram. CMR results showed late gadolinium enhancement while LVOT gradient and cardiac output were not significantly affected, along with increased inflammatory response, are indicative of myocarditis. Thus, chest pain is not always an indicator of left ventricular outflow tract elevation in patients with hypertrophic cardiomyopathy.
