Article Text

  1. K. Obunai,
  2. D. Misra,
  3. P. Schweitzer
  1. Beth Israel Medical Center, New York


Introduction Several case series of transient left ventricular apical ballooning syndrome, also known as Tako-Tsubo cardiomyopathy, have been reported predominantly in the Japanese population. We present a white female patient with Tako-Tsubo cardiomyopathy in whom profoundly decreased glucose utilization was observed.

Case Report A 52-year-old female with no previous cardiac history was brought to the emergency room twelve hours after the acute onset of chest pain and shortness of breath, which were triggered by an emotional argument with her husband. On arrival, her blood pressure was 77/50 mm Hg and heart rate was 88 beats/min. Jugular venous distention was appreciated in the sitting position and respiratory crackles were heard in bilateral lung fields. Electrocardiogram revealed mild ST elevation in leads II, III, aVF with diffuse T wave inversion. A chest radiograph was consistent with bilateral pulmonary parenchymal congestion. Emergent coronary angiography revealed normal coronary arteries. Left ventriculography showed distal anterior, apical and distal inferior akinesis with hyperkinesis of the remaining walls (Figures). Her serum troponin T was mildly elevated at 0.64 ng/mL. Over the next three days, she showed a marked clinical improvement with resolution of heart failure. Metabolic imaging with positron emission tomography (PET) revealed markedly reduced fluorine-18 fluorodeoxyglucose (FDG) uptake in the akinetic apical wall with relatively normal perfusion. Echocardiography was repeated three months later, which showed normalization of left ventricular wall motion. Repeat PET imaging revealed marked improvement of FDG uptake in the apical wall.

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