["Chestnut-shaped" transient regional left ventricular hypokinesis with abnormal myocardial fatty acid metabolism, not corresponding to the coronary artery territories: a case report].
ABSTRACT A 79-year-old female patient, who was initially suspected to have pneumonia, was admitted to the respiratory department of our hospital. She experienced chest pain on the second admission day. Electrocardiography showed ST-segment elevation in leads V3 through V6, and echocardiography revealed hypokinetic left ventricular wall motion. Therefore, myocardial infarction was suspected. She was transferred to the coronary care unit. Heart catheterization was immediately performed. Coronary angiography showed no significant stenotic lesion. Left ventriculography showed regional hypokinesis of the anterior and posterior walls near the base and normokinesis in the apex. Iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (123-BMIPP)myocardial single photon emission computed tomography(SPECT) revealed inhomogeneous decrease in uptake, especially in the lateral wall, which did not correspond to any of the coronary artery territories. The echocardiographic asynergy was dramatically resolved after 1 week and the 123I-BMIPP SPECT finding was normal at 3 months. Although the clinical course of this patient was similar to that of tako-tsubo-like left ventricular dysfunction, the shape of her left ventricle was not typical. Left ventriculography showed hypokinesis of the anterior and posterior walls near the base and normokinesis in the apex, appearing like a chestnut rather than a tako-tsubo.
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ABSTRACT: Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) is characterized by transient left ventricular apical ballooning associated with symptoms, electrocardiographic changes and minimal cardiac enzyme release in the absence of coronary artery disease. Initially described in Japan, TTP occurs worldwide, predominantly in women and frequently after emotional or physical stress. Symptoms include anginal chest pain, dyspnea and syncope. Electrocardiographic ST elevations may be present only for several hours, and are followed by negative T waves that persist for months. Arterial hypertension is found in up to 76% of TTP patients, hyperlipidemia in up to 57% and diabetes mellitus in up to 12%. Potential pathophysiological mechanisms for TTP include catecholamine-induced myocardial stunning or hyperkinesis of the basal left ventricular segments, coronary vasospasm, plaque rupture, myocarditis and genetic factors. TTP patients should be monitored similarly to myocardial infarction patients because organ failure, cardiogenic shock, ventricular fibrillation or rupture may occur. Beta-blockers are indicated, whereas catecholamines and nitrates should be avoided. The long-term prognosis is unknown.The Canadian journal of cardiology 11/2006; 22(12):1063-8. · 3.12 Impact Factor
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ABSTRACT: The aim of our study is to assess the incidence and clinical significance of right ventricular (RV) involvement in Takotsubo cardiomyopathy (TTC). Between February 2002 and December 2005, 47 patients with TTC underwent cardiovascular magnetic resonance (CMR) at our institutions. 13 patients with delayed initial CMR were excluded. In the remaining 34 patients (32 women), RV wall motion abnormalities (WMAs) were present in nine (26%). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV involvement (40 +/- 6 vs. 48 +/- 10%, P = 0.04). The most frequently affected RV segments were the apico-lateral (89%), the antero-lateral (67%), and the inferior segment (67%). All RV WMA improved or disappeared in eight of nine patients who underwent a follow-up CMR study. Pleural effusion was more common in patients with RV involvement (67 vs. 8%, P < 0.001) and was predictive of RV dysfunction (sensitivity 67% and specificity 92%). Significant or bilateral pleural effusions were seen exclusively in patients with RV involvement. RV involvement is common in TTC and seems to be associated with a more severe impairment in LV systolic function. It may be suspected by the presence of pleural effusion.European Heart Journal 11/2006; 27(20):2433-9. · 14.10 Impact Factor
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ABSTRACT: A 57-year-old female patient, who was initially suspected to have subarachnoid hemorrhage, was admitted to our hospital. She experienced severe dyspnea and chest pain owing to pneumonia on the fourth admission day. Electrocardiography showed ST-segment elevation in leads V(2) through V(5), and echocardiography revealed hypokinetic left ventricular wall motion. No stenosis was found in the coronary arteries by urgent coronary angiography. However, left ventriculography revealed that the basal and apical areas were hyperkinetic and the mid portion was akinetic. After a month, left ventricular wall motion was improved and coronary artery spasm provocation tests were negative. Although the clinical course of this patient was similar to that of neurogenic myocardial stunning, the shape of her left ventricle was not typical.Journal of Cardiology 08/2008; 52(1):53-8. · 2.30 Impact Factor