Article

["Chestnut-shaped" transient regional left ventricular hypokinesis with abnormal myocardial fatty acid metabolism, not corresponding to the coronary artery territories: a case report].

Department of Cardiovascular Medicine, Japanese Red Cross Medical Center, Hiroo 4- 1-22, Shibuya-ku, Tokyo 150- 8935.
Journal of Cardiology (Impact Factor: 2.78). 07/2004; 43(6):273-80.
Source: PubMed

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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    • "Although the clinical course of this patient suggested neurogenic myocardial stunning, the pattern of left ventricular dyskinesis, i.e., akinesis in the middle of the left ventricle and hyperkinesis in the basal and apical regions, differed from that in typical cases. Systolic morphological abnormalities such as the inversed takotsubo type showing akinesis in the basal region and hyperkinesis in the apical region [4] (chestnut type [5]) and the sandglass type showing akinesis in the apical and basal regions and hyperkinesis in the middle of the left ventricle [6] have been reported sporadically as variations of takotsubo cardiomyopathy. "
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