南予医誌 Vol.14 No. １ 2013－64－Figure 2: Change in Doppler flow velocity profiles and M-mode echocardiography at the mitral valve level on admission (A) and at day 7 (B). Continuous Doppler recording demonstrates that a severe pressure gradient, estimated at 86 mmHg on admission, returned to normal at day 7. M-mode echocardiography shows the disappearance of the systolic anterior motion of the mitral valve observed on admission. ABSAM4.7m/s86mmHg1.2m/s5.8mmHgFigure 2demonstrated akinesis of the left ventricular apex with hyperkinesis of the basal area. Doppler echocardiography demonstrated a left ventricular pressure gradient of 86 mmHg with systolic anterior motion of the mitral valve (Figure 2A). Emergency coronary angiography was performed to ascertain the cause of the apical asynergy. However, no signicant epicardial coronary stenosis was found (Figure 3A), while left ventriculography showed asynergy of apical ballooning with basal hyperkinesis (Figure 3B). The coronary flow velocity pattern was normal, but the coronary ow reserve (CFR) of the left anterior descending coro-nary artery was decreased by 1.3-fold after administration of adenosine triphosphate (ATP) (Figure 4A). An intravenous inotropic agent that had been administered from the time of admission was ceased. Propranolol (4 mg) was administered intravenously un-der electrocardiographic and hemodynamic monitoring. Ten minutes after propranolol injection, the left ventricular pressure gradi-ent decreased to 53 mmHg, and the blood pressure increased to 96/62 mmHg. Oral carvedilol (10 mg daily) was started, and the echocardiographic wall motion abnor-malities disappeared within 7 days. The maximal plasma level of creatine kinase was 256 IU/l. No elevation in viral antibody ti-ters was observed during hospitalization. On 7 day of admission, I-123-MIBG myo-cardial scintigraphy was performed. De-creased uptake of I-123-MIBG was found in the apical region. The heart–mediastinum
元のページ ../index.html#66