A case of Crush syndrome with giant negative T waves and reversible left ventricular dysfunction

A 54-year-old male experienced the Hanshin earthquake at 5:46 am on Jan. 17, 1995. He was rescued after being buried under his house for 20 h. After being treated at two hospitals, he was admitted to our hospital with acute renal failure caused by crush syndrome. The maximal serum creatinine kinase level was 35,000 IU/L (CK-MM: 100%), and the maximal myoglobin level was 12,600 ng/ml. An electrocardiogram showed inverted T waves in V5,6 which later became giant negative T waves, and a QS pattern in a VL and V1-6. Two-dimensional echocardiography showed a hypokinetic left ventricle. He was treated with hemodialysis 13 times. Cardiac contraction gradually improved to the normal level. Coronary angiography revealed normal coronary arteries and acetylcholine did not induce coronary spasm. Biopsy specimens from the right ventricular septum showed slight degeneration. 201Tl imaging showed hypoperfusion except in the anterior wall and 123I-MIBG imaging showed a perfusion defect except in the anterior wall. After about 1 month, only 201Tl imaging showed improvement. We believe that myocardial ischemia, cardiac sympathetic nerve damage and/or cardiac contusion caused giant negative T waves and left ventricular dysfunction. This is a rare case which showed significant myocardial damage with crush syndrome.