Assessment of coronary morphology and flow in a patient with Guillain-Barre syndrome and ST-segment elevation

Patients with Guillain-Barre syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhy thmias and disturbances of heart rate and blood pressure. We report a case of a patient with Guillain-Barre syndrome who developed ST-segment elevatio n in the inferolateral leads, suggestive of an acute coronary syndrome. Car diac catheterization revealed angiographically normal coronary arteries. In tracoronary ultrasound was also normal. Intracoronary Doppler now measureme nts revealed an elevated baseline coronary flow velocity of up to 41 cm/s a nd decreased coronary flow reserve, particularly in the left circumflex art ery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myoca rdial blood flow.