Reversible left ventricular dysfunction "takotsubo" cardiomyopathy related to catecholamine cardiotoxicity.
An 80-year-old female was admitted for a persistent consciousness disturbance. Electrocardiography revealed ST-segment elevation in leads II, III, aVf, and V3-V6. Coronary angiography demonstrated normal arteries, while left ventriculography revealed asynergy of apical akinesis and basal hyperkinesis. The creatinine kinase and creatinine kinase MB levels were not elevated after the initial measurement on admission. The diffuse ST-segment elevation reached a maximum level 24 hours after admission. In leads V3-V6, ST-segment elevation continued for 48 hours, and was followed-up by deep inverted T waves. Within 24 days, the asynergy improved without any specific treatment, but the giant negative T waves were present on the electrocardiogram. The plasma norepinephrine and brain natriuretic peptide levels on the first hospital day were 2.9ng/mL and 906pg/mL, respectively. The left ventricular dysfunction appeared to be induced by the exposure to high-level plasma catecholamines. (123)I-metaiodobenzyl guanidine scintigraphy also revealed transient dysfunction of the cardiac catecholamine dynamics.
Akashi
Yoshihiro J
YJ
Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-city, Kanagawa-pref, Japan. johnny@marianna-u.ac.jp
Nakazawa
Kiyoshi
K
Sakakibara
Masayoshi
M
Miyake
Fumihiko
F
Sasaka
Kaoru
K
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood* / Q000139:chemically induced*; D002395:Catecholamines / Q000097:blood* / Q000633:toxicity; D004562:Electrocardiography; D005260:Female; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood / Q000633:toxicity; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000139:chemically induced*
D015415:Biomarkers; D002395:Catecholamines; D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine