title: 'Tako-Tsubo cardiomyopathy' associated with syndrome malin: reversible left ventricular dysfunction.
abstract: A 66-year-old man developed a fever and had a syncopal attack during treatment with imipramine and amantadine for depression and Parkinson's disease. His muscular enzyme levels were very high, so he was diagnosed with incomplete syndrome malin and given hydration therapy. The electrocardiogram recorded an ST segment elevation like acute myocardial infarction in most leads, and the echocardiogram revealed left ventricular dysfunction with severe hypokinesis to dyskinesis of the anterior and apical wall regions, and hyperkinesis of the basal wall. One month from onset, the left ventricular contractility had not changed despite normal coronary arteries. Thallium-201((201)Tl) myocardial scintigraphy showed a perfusion defect and there was no accumulation of iodine-123((123)I) metaiodobenzylguanidine (MIBG) in the entire apex of the heart. Left ventricular function returned to normal and repeat (201)Tl scintigraphy showed recovery by the 4th month. However, there was still an absence of cardiac MIBG uptake. There are a number of reports from Japan of a syndrome demonstrating such reversible left ventricular dysfunction, called 'tako-tsubo cardiomyopathy', but the present case is the first to be associated with syndrome malin. A coronary microvascular abnormality and cardiac sympathetic denervation probably both play an important role in tako-tsubo cardiomyopathy.
authors.affiliation: Department of Cardiology, Bokutou Metropolitan Hospital, Tokyo, Japan.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kawabata
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kubo
authors.forename: Kou
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Terai
authors.forename: Touru
authors.initials: T
authors.lastname: Iwama
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000547:Amantadine / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology*; D017023:Coronary Angiography; D006801:Humans; D007099:Imipramine / Q000009:adverse effects; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000150:complications*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D013794:Thallium Radioisotopes; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D019797:3-Iodobenzylguanidine; D000547:Amantadine; D007099:Imipramine