REVERSIBLE LEFT-VENTRICULAR DYSFUNCTION ASSOCIATED WITH GUILLAIN-BARRE-SYNDROME - AN EXPRESSION OF CATECHOLAMINE CARDIOTOXICITY

The patient was a 76-year-old female who had a history of Guillain-Bar re syndrome 3 years previously; ST-segment elevation was noted in asso ciation with reversible left ventricular dysfunction. Left ventrioculo gram and coronary angiograms were normal and ergonovine test was negat ive during the chronic period of Guillain-Barre syndrome. She was hosp italized again due to the recurrence of Guillain-Barre syndrome. Two d ays later, ST-segment elevation in leads V-2 through V-5 prompted us t o perform cardiac catheterization, although she did not complain of an y chest symptoms. A large akinetic area was found mainly around the ap ex on left ventriculography, despite the lack of coronary stenoses. Pe ak creatine kinase and C-reactive protein were 400 IU/ml and 3.5 mg/dl , respectively. Left ventricular dysfunction was normalized within one week. During the acute phase of the cardiac episode, plasma norepinep hrine and epinephrine were 1340 pg/ml and 112 pg/ml, respectively. I-1 23 metaiodobenzylguanidine myocardial scintigram 3 weeks after the epi sode showed an extensive apical defect which was improved markedly 3 m onths later. We think that this reversible left ventricular dysfunctio n was due to the synergistic toxic effect of mildly increased catechol amine and transiently damaged sympathetic nerve endings in the myocard ium, presumably due to Guillain-Barre syndrome.