Alcohol drinking triggers acute myocardial infarction in a case of hypertrophic obstructive cardiomyopathy

Alcohol ingestion–related increased left ventricular outflow tract (LVOT) pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM) has been reported in the literature; however, acute myocardial infarction (AMI) after alcohol drinking in this patient group is rarely reported. Herein, we report a 68-year-old man with chronic alcoholism suffering from AMI after alcohol drinking. Electrocardiography revealed complete left bundle branch block, and chest X-ray showed acute pulmonary edema. Intubation was done for respiratory failure and intra-aortic balloon pump was also inserted for unstable hemodynamics. However, emergent coronary angiography revealed normal coronary arteries. HOCM was diagnosed by a high pressure gradient over LVOT and systolic anterior motion of mitral valve by echocardiography. This patient became stable under intensive care and medical treatment. This case reminds physicians that alcohol ingestion might cause AMI in HOCM patients because of increased LVOT pressure gradient and decreased coronary perfusion despite normal coronary arteries.

摘要在阻塞性肥厚心肌症病患因為喝酒造成左心室流出道壓力差上升已經有文獻報告過。然而，喝酒後發生急性心肌梗塞在阻塞性肥厚心肌症族群則很少被報導。我們在此報告一位68歲有慢性酒精中毒的男性病患在喝酒後發生急性心肌梗塞。心電圖上顯示是完全性左側支束傳導阻滯以及胸部X光片顯示為急性肺水腫。這個病患因為呼吸衰竭被插管，也由於血行動力學不穩定被放置了主動脈內氣球幫浦。然而緊急心導管的結果發現其冠狀動脈並無異常。阻塞性肥厚心肌症是在左心室造影時發現在左心室流出道有較高的壓力差並且在超音波上發現僧帽瓣有收縮期的前移運動。這個病患最後在加護病房照護以及藥物治療下逐漸穩定。這個案例告訴我們，儘管是在冠狀動脈正常的情況下，喝酒可能會使有阻塞性肥厚心肌症的病患發生急性心肌梗塞，其原因可能是由於上升左心室流出道的壓力差並造成冠狀動脈的灌流量減少所導致。