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Cardiology - Structural Heart
A 31-year-old woman with known hypertrophic cardiomyopathy presented with intermittent chest pain despite treatment with metoprolol succinate 100 mg once daily. Transthoracic echocardiography demonstrated marked septal hypertrophy with a resting left ventricular outflow tract gradient of 80 mmHg. After other potential causes of her symptoms were excluded, she was diagnosed with chronic stable angina. Her beta-blocker dose was increased, and she was discharged for outpatient follow-up.
One year later, she returned to the emergency department with similar symptoms despite beta-blocker therapy. Left heart catheterisation demonstrated normal coronary arteries, making significant epicardial coronary artery disease unlikely as the cause of her persistent angina. Her symptoms were considered in the context of hypertrophic cardiomyopathy, where myocardial hypertrophy and microvascular ischaemia may contribute to chest pain.
With persistent anginal symptoms despite beta-blockade and no obstructive coronary artery disease, an additional antianginal strategy was considered. Ranolazine was initiated and subsequently titrated to 1000 mg twice daily during outpatient follow-up. On combination therapy with metoprolol and ranolazine, the patient reported significant improvement in her anginal symptoms.
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As the management of chronic angina continues to evolve, understanding the clinical value of novel therapeutic approaches has become increasingly important. Coronary Connect is a scientific forum dedicated to fostering clinical learning through evolving treatment strategies, practical insights, and meaningful scientific exchange, empowering healthcare professionals to deliver personalized, evidence-based care and improve patient outcomes.
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