Intestinal angina in a patient with hypertrophic obstructive cardiomyopathy: a case report.
BACKGROUND
Intestinal angina is characterized by recurrent postprandial abdominal pain and anorexia. Commonly, these symptoms are caused by severe stenosis of at least two vessels among the celiac and mesenteric arteries. However, intestinal perfusion is affected not only by the degree of arterial stenosis but also by systemic perfusion. We experienced a unique case of intestinal angina caused by relatively mild stenosis of the abdominal arteries complicated with hypertrophic obstructive cardiomyopathy.


METHODS
We report an 86-year old Japanese man with hypertrophic obstructive cardiomyopathy and advanced atrioventricular block who was diagnosed with intestinal angina. Computed tomography showed mild stenosis of the celiac artery and severe stenosis of the inferior mesenteric artery, and these lesions were relatively mild compared with other reports. A dual-chamber pacemaker with right ventricular apical pacing was implanted to improve the obstruction of the left ventricular outflow tract. After implantation, the patient's abdominal symptoms diminished markedly, and improvement of the left ventricular outflow tract obstruction was observed.


CONCLUSIONS
Although intestinal angina is generally defined by severe stenosis of at least two vessels among the celiac and mesenteric arteries, the present case suggests that hemodynamic changes can greatly affect intestinal perfusion and induce intestinal angina in the presence of mild stenosis of the celiac and mesenteric arteries.
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. tokuta114@yahoo.co.jp.
Takuto
T
Hamaoka
Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
Wataru
W
Omi
Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
Yoshiteru
Y
Sekiguti
Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
Shigeo
S
Takata
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Shuichi
S
Kaneko
Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
Oto
O
Inoue
Department of Cardiology, Kanazawa Municipal Hospital, Kanazawa, Japan.
Shinichiro
S
Takashima
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Hisayoshi
H
Murai
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Soichiro
S
Usui
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Takeshi
T
Kato
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Hiroshi
H
Furusho
Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Masayuki
M
Takamura
Advanced atrioventricular block; Case report; Hypertrophic obstructive cardiomyopathy; Intestinal angina
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