IKEDA et al.：Ampulla cardiomyopathy and β-blocker南予医誌 Vol.14 No. １ 2013－63－with chest pain, and electrocardiographic changes that simulate acute myocardial in-farction, was rst reported by Stoh et al. in 1989.1 The most remarkable feature of its epidemiology is its high prevalence among postmenopausal women.2-4 However, the precise pathophysiological mechanism and predisposition of postmenopausal women remain unknown. We present herein a case of ampulla cardiomyopathy demonstrating a transient severe left ventricular obstruction successfully treated with a β-blocker and impairment of the coronary microcircula-tion. The findings in this case may lead to some speculation with regard to the cause of this syndrome.Case presentation An 82-year-old female patient presented herself to our emergency department be-cause of severe chest pain and dyspnea with no somatic or psychological stress. On admission, physical examination revealed a blood pressure of 62/24 mmHg, body temperature of 36.2°C, and heart rate 124 beats/minute. A harsh 3/6 systolic murmur was heard along the left parasternal border. Electrocardiography showed ST-segment elevation in leads I, II, aVL, aVF, and V2–V6 (Figure 1A). Chest radiography showed cardiomegaly with pulmonary artery engorgement. Laboratory tests revealed an increase in the white blood cell count (10,900/mm3), positivity for heart-type fatty acid-binding protein, and normal levels of creatine kinase (185 IU/l). Of the three catecholamine fractions, only dopamine was elevated at 32 pg/dl. Echocardiography Figure 1: Serial electrocardiographic changes. On admission (A), at day 7 (B), and at 6 months (C).ABCIIIIIIaVRaVLaVFV1V2V3V4V5V6IIIIIIaVRaVLaVFV1V2V3V4V5V6V1V2V3V4V5V6IIIIIIaVRaVLaVFFigure 1
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