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83 TWO NOTABLE CASES OF MYOCARDIAL STUNNING
  1. G. P. Kelley,
  2. D. L. Glancy
  1. Louisiana State University School of Medicine, New Orleans

Abstract

Transient, reversible left ventricular dysfunction may be observed in a variety of clinical-pathologic settings, including ischemic and non-ischemic insults. Relatively brief episodes of ischemia resulting in left ventricular dysfunction which improves within hours to days is referred to as “stunning.” In contrast, hibernating myocardium, which is the result of prolonged and/or repetitive ischemia, is defined by functional improvement only after revascularization. The pathogenesis of ischemic myocardial stunning is mutifactorial, with apparent synergistic interaction between the component factors. Three important factors are increased production of oxygen derived free radicals, alterations in calcium homeostasis, and reduced sensitivity of myofilaments to calcium. We present two remarkable cases of ischemic myocardial stunning. In the first case a forty-four-year-old woman presented with typical anginal type pain, hypotension, pulmonary edema and marked electrocardiographic changes suggesting global myocardial ischemia. Profound, reversible left ventricular dysfunction (left ventricular ejection fraction nadir 10%) was attributed to spasm of the left main coronary artery. The second case describes recurrent myocardial stunning in the setting of a distal right coronary lesion before angioplasty and after subsequent in-stent re-stenosis. Each time the apical one-half of the left ventricle became dyskinetic. Left ventricular ejection fraction returned to normal both after the first and again after the repeat angioplasty.

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