Multimodality imaging in a patient with non-obstructive hypertrophic cardiomyopathy and multivessel coronary artery disease presenting with chest pain: a case report

Introduction Hypertrophic cardiomyopathy (HCM) and atherosclerotic coronary artery disease (CAD) are distinct entities but may coexist, particularly in patients with traditional cardiovascular risk factors. In individuals with HCM, chest pain is frequently attributed to microvascular dysfunction or diastolic impairment, which may obscure the presence of concomitant epicardial stenosis. This diagnostic overlap poses significant clinical challenges and may lead to delayed recognition of obstructive CAD. Case presentation A 43-year-old man with hypertension and dyslipidemia presented with a 2-year history of intermittent chest pain that had recently worsened. Physical examination was unremarkable. Echocardiography and cardiac magnetic resonance imaging revealed asymmetric septal hypertrophy with preserved systolic function, consistent with non-obstructive hypertrophic cardiomyopathy, along with perfusion defects indicating myocardial ischemia. Laboratory tests showed elevated NT-proBNP and high-sensitivity troponin I without dynamic rise. Coronary imaging demonstrated multivessel atherosclerotic disease with severe mid–right coronary artery stenosis. He underwent successful percutaneous coronary intervention with a drug-eluting stent and was started on guideline-directed medical therapy. At two-week follow-up, his chest pain had completely resolved. Conclusion This case underscores the importance of comprehensive multimodal imaging in evaluating chest pain in patients with HCM, as microvascular ischemia can mask the presence of obstructive CAD. Early identification and appropriate revascularization of concomitant epicardial stenosis are essential to optimize clinical outcomes. Trial registration This study is a case report and dose not involve a clinical trial; therefore,trial registration is not applicable.