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Reversible left ventricular systolic dysfunction--reversibility of coronary microvascular abnormality
J Ako1, K Takenaka, K Uno
1Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Japan.
Japanese Heart Journal
|October 19, 2001
Summary
Reversible left ventricular dysfunction mimicking heart attack can occur in noncardiac illness. Impaired coronary microcirculation, not artery blockage, is the likely cause of this temporary heart muscle abnormality.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Reversible left ventricular wall motion abnormalities can mimic myocardial infarction in noncardiac conditions.
- Coronary angiograms in these cases typically show no significant organic stenosis or epicardial coronary vasospasm.
Observation:
- Two cases presented with reversible left ventricular contraction abnormalities.
- Electrocardiography showed deep inverted T waves; echocardiography revealed diffuse apical akinesis.
- Coronary angiography was normal, but metaiodobenzylguanidine scintigraphy showed apical defects.
Findings:
- Reduced relative coronary flow reserve ratio was observed in both patients.
- Myocardial contrast echocardiography indicated a reversible apical perfusion defect in one patient.
- Transiently impaired coronary microcirculation is implicated in the pathogenesis.
Implications:
- This dysfunction highlights the importance of considering microcirculatory issues in unexplained cardiac abnormalities.
- Understanding these mechanisms can refine diagnostic and therapeutic strategies for non-ischemic cardiac events.