A CASE OF CRUSH SYNDROME WITH GIANT NEGATIVE T-WAVE AND REVERSIBLE LEFT-VENTRICULAR DYSFUNCTION

A 54-year-old male experienced the Hanshin earthquake at 5:46 am on Ja n. 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 hospit al with acute renal failure caused by crush syndrome. The maximal seru m creatinine kinase level was 35,000 IU/L (CK-MM: 100%), and the maxim al myoglobin level was 12,600 ng/ml. An electrocardiogram showed inver ted T waves in V-5,V-6 which later became giant negative T waves, and a QS pattern in a VL and V-1-6 Two-dimensional echocardiography showed a hypokinetic left ventricle. He was treated with hemodialysis 13 tim es. Cardiac contraction gradually improved to the normal level. Corona ry angiography revealed normal coronary arteries and acetylcholine did not induce coronary spasm. Biopsy specimens from the right ventricula r septum showed slight degeneration. Tl-201 imaging showed hypoperfusi on except in the anterior wall and I-123-MIBG imaging showed a perfusi on defect except in the anterior wall. After about 1 month, only Tl-20 1 imaging showed improvement. We believe that myocardial ischemia, car diac sympathetic nerve damage and/or cardiac contusion caused giant ne gative T waves and left ventricular dysfunction. This is a rare case w hich showed significant myocardial damage with crush syndrome.