[Left ventricular hypertrophy and myocardial ischemia (coronary atherosclerosis excluded)].

The diagnosis of myocardial ischemia due to coronary artery disease in the presence of left ventricular hypertrophy associated with chest pain and ST-T wave changes is difficult. Resting and exercise ST changes are not specific and even stress or dipyridamole Thallium scintigraphy may give erroneous results. In fact, the changes of myocardial perfusion induced by left ventricular hypertrophy reflect a reduction of coronary vasodilator reserve and the increased coronary vascular resistance explains the angina with normal coronary arteries observed in these patients. The reduction of coronary reserve is the result of complex and controversial processes: increased vascular compression, reduction of capillary density: hypertrophy of the arteriolar media or simply changes in coronary vasomotricity. Understanding these abnormalities implies appropriate antihypertensive treatment: lowering the blood pressure, reducing the myocardial hypertrophy and improving subendocardial perfusion.