title: Vulnerability of myocardial collateral perfusion: the impact of episodic hypertension.
abstract: In patients with coronary artery disease, the presence of left ventricular hypertrophy secondary to hypertension is associated with an increased collateral development. A patient is described who was admitted for myocardial ischemia and severe hypertension. One day after admission, coronary angiography revealed a proximal chronic occlusion of the left anterior descending artery with an extensive collateral vascularization originating from the right and circumflex coronary arteries. In addition, left ventriculography showed antero-apical akinesia that was resolved 5 days later, indicating myocardial stunning. This case illustrates the vulnerability of collateral coronary blood flow to an episode of hypertension, giving rise to myocardial ischemia and even myocardial stunning. This finding advocates aggressive antihypertensive therapy in patients with coronary artery disease and regional myocardial perfusion, which exclusively depends on collateral blood flow.
authors.affiliation: Department of Cardiology, Centre de Cardiologie, Hôpital Universitaire de Genève, 24 rue Micheli-du-Crest, 1211 Genève 14, Switzerland.
authors.forename: G Aernout
authors.initials: GA
authors.lastname: Somsen
authors.forename: Alberto
authors.initials: A
authors.lastname: Righetti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Camenzind