'Tako-tsubo' transient ventricular dysfunction - A case report

During admission for investigation of dysphagia, an 82-year-old woman sudde nly complained of dyspnea, which was followed by cardiogenic shock. Her sym ptoms, electrocardiogram, echocardiogram and laboratory data were compatibl e with an extensive acute anterior myocardial infarction. Emergency cardiac catheterization showed no atheromatous narrowing in any coronary artery. H owever, the contractions of the left and right ventricles were diffusely an d severely impaired, except for some hyperkinesis of the basal area. The as ynergy, as well as the abnormalities on the ECG, improved almost to normal by the 35th hospital day. An endomyocardial biopsy from the right ventricle during the acute phase showed atypical myocardial damage with proliferatio n of fine collagen fibers and small round-cell infiltration including polym orphologic leukocytes. This type of transient cardiac disorder has recently been described in Japan, and is called 'Tako-tsubo cardiomyopathy' because of the characteristic appearance of the left ventricular asynergy. In the present case, ventricular asynergy was not limited to the left ventricle, b ut was also present in the right ventricle.