title: Progressive restrictive cardiomyopathy--a case report.
abstract: We present a case of restrictive cardiomyopathy which progressed over a 10 month period. A 69-year-old female was admitted because of acute inferior myocardial infarction; hemodynamically, she was in Forrester subset I. Cardiac catheterization performed 4 weeks post-infarction showed markedly increased left ventricular end-diastolic and pulmonary wedge pressures. Left ventricular ejection fraction was 66% with postero-basal akinesis and minimal mitral regurgitation. The right coronary artery was completely occluded with good collateral circulation from the intact left coronary artery. Doppler echocardiography 4 weeks post-infarction showed pseudo-normalization of the A/E ratio of peak mitral flow velocity in atrial systole (A) to peak mitral flow velocity in early diastole (E). Preload reduction by nitroglycerin increased the A wave. Ten months post-infarction, the patient was re-admitted due to congestive heart failure. The A/E ratio was unchanged, however the A wave no longer increased after the same dose of nitroglycerin. We have hypothesized that dehydration and/or the vigorous use of a nitrate, in the acute phase of myocardial infarction, masked an underlying restrictive cardiomyopathy which progressed in the 10 months post-infarction.
authors.affiliation: Department of Cardiology, Tenri Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iga
authors.forename: S
authors.initials: S
authors.lastname: Kitaguchi
authors.forename: K
authors.initials: K
authors.lastname: Hori
authors.forename: T
authors.initials: T
authors.lastname: Matsumura
authors.forename: G
authors.initials: G
authors.lastname: Tomonaga
authors.forename: H
authors.initials: H
authors.lastname: Gen
authors.forename: T
authors.initials: T
authors.lastname: Tamamura
mesh_terms: D001783:Blood Flow Velocity; D002313:Cardiomyopathy, Restrictive / Q000150:complications*; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011669:Pulmonary Wedge Pressure; D013599:Systole