title: [So-called "ampulla" cardiomyopathy associated with coronary vasospasm compared with acute myocardial infarction showing similar abnormal left ventricular wall motion: two case reports].
abstract: So-called "ampulla" cardiomyopathy is characterized by transient abnormal left ventricular wall motion showing hypokinesia around the apical area and hyperkinesia at the basal area, without any detectable coronary lesion. We recently treated a patient with "ampulla" cardiomyopathy (Case 1) and a patient with acute myocardial infarction showing similar abnormal left ventricular wall motion (Case 2). A 75-year-old female (Case 1) presented with "ampulla" cardiomyopathy without coronary lesion. Vasospasm was induced at segment 8 on the left anterior descending (LAD) coronary artery by intracoronary administration of acetylcholine. A 58-year-old male (Case 2) presented with acute myocardial infarction due to occlusion at segment 8 and underwent successful coronary reperfusion therapy by direct percutaneous transluminal coronary angioplasty. Both Case 1 and Case 2 revelaed similar abnormal left ventricular wall motion, with hypokinesia around the apical area and hyperkinesia at the basal area by echocardiography, in the acute phase. Furthermore, these two patients showed elevated ST segment at both anterior and inferior leads by electrocardiography, and markedly reduced uptake of beta-methyl-p-iodophenyl-pentadecanoic acid around the apical area in the acute phase by scintigraphy. Interestingly, the LAD perfused a relatively wide area including the anterior, apical and part of the inferior area of the left ventricle in both patients by coronary angiography. The abnormal wall motion of Case 1 disappeared 4 weeks after onset, but that of Case 2 did not disappear. Although the diagnoses of Case 1 and Case 2 were different, abnormal wall motion of these cases might be due to myocardial ischemia due to distal LAD lesion. "Ampulla" cardiomyopathy might develop from transient myocardial ischemia induced by coronary vasospasm at the distal LAD which perfuses a relatively wide area.
authors.affiliation: Division of Cardiology, Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Nishiiwata 3-4-13, Higashiosaka, Osaka 578-0947.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Inoue
authors.forename: Makoto
authors.initials: M
authors.lastname: Takaoka
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Kumura
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tohma
authors.forename: Shigeru
authors.initials: S
authors.lastname: Shiono
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Tabuse
authors.forename: Toshio
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Yuta
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsushima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kijima
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000150:complications*; D005227:Fatty Acids; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology*; D011877:Radionuclide Imaging; D016277:Ventricular Function, Left
chemical_list: D005227:Fatty Acids; D007462:Iodobenzenes; C049338:iodofiltic acid