Emotional stress-induced 'ampulla cardiomyopathy' - Discrepancy between the metabolic and sympathetic innervation imaging performed during the recovery course

Four patients had the clinical features of 'ampulla cardiomyopathy', consis ting of acute-onset transient left ventricular apical akinesis with basal n ormokinesis, normal coronary angiogram, ST-segment elevation and subsequent giant T wave inversion, which mimicked acute coronary syndrome, the onset of which occurred shortly after extreme mental stress. Myocardial necrosis was minimal, although 2 patients showed elevated serum catecholamine levels in the acute phase. Each patient underwent serial cardiac radionuclide sin gle-photon emission computed tomography of myocardial functional sympatheti c innervation, fatty acid metabolism and perfusion using I-123-metaiodobenz yl-guanidine (MIBG), I-123-beta -metyl-iodophenyl pentadecanoic acid (BMIPP ) and thallium-201 ((201T)l), respectively. In the acute phase, MIBG and BM IPP imaging showed an uptake defect in the apical region, whereas Tl-201 up take was mildly decreased. When assessed semi-quantitatively, the MIBG imag es had higher defect scores from the acute phase throughout the year of obs ervation compared with BMIPP, and 201Tl. These observations suggest that th e primary cause of ampulla cardiomyopathy is related to a disturbance of th e cardiac sympathetic innervation.