Effects of Essential Hypertension on Coronary Microcirculation: Case Report

Abstract

Background: Hypertension is one of the most widespread cardiovascular risk factor that underlies the establishment of atherosclerotic deterioration of arterial walls. Microvascular abnormalities can both results from and contribute to hypertension. Heart is organ that may suffer end-organ damage with changes in myocardial microvessel structure and density. This changes of the circulation are associated with chest pain and the reason for ischemia is still found within epicardial vessels (stenosis, coronary spasm, myocardial bridges, endothelial dysfunction), but in some cases none of the suitable causes can be found. In this context we talk about microvascular angina. Methods: We present a clinical case of 64 years old female patient with chest pain a few days before actual hospitalization and 15 years history of hypertension. This is second hospitalization of the patient; in previous one she had chest pain and coronary angiography was performed but without detection of significant coronary artery lesion. We performed several clinical investigations during actual hospitalization: blood chemistry, electrocardiograms (ECG), 24-hour ECG Holter monitoring, carotid Doppler ultrasonography (CDU), echocardiography (ECHO), myocardial perfusion scintigraphy (MPS), as well as coronary angiography (CA). Results: Physical examination and biochemical parameters were normal, with pathological ECG detecting Q-wave in anteroseptal leads and left anterior hemiblock. Twenty four-hour Holter ECG monitoring showed rhythm disturbances in terms of single multifocal ventricular extrasystoles with periods of bigeminy and trigeminy, as well as single and pairs of supraventricular extrasystoles. CDU finding was normal. ECHO revealed reduced global left ventricle contractility with impaired segmental kinetics of the middle and apical segment of the interventricular septum and anterior wall with EF 36%. MPS was pathological and showed wide region of perfusion defect (sequela) in multiple segments encompassing 48% of the left ventricle muscular mass including apical aneurysm. At the end, CA was performed but it did not detect any significant coronary artery lesion. Conclusion: Abnormalities of microvessel structure and microvascular network density often accompany and may be an important cause of primary hypertension. Microcirculatory abnormalities are also likely to be central to many forms of hypertensive end-organ damage including those involving heart, especially coronary artery disease.