南予医学雑誌 第14巻
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南予医誌 Vol.14 No. 1 2013-68-hibitory effect on the expression of cardiac adrenergic receptors. We cannot extrapolate these experimental reports to humans, but we can speculate that the intrinsic adrener-gic hypersensitivity in the estrogen-deprived state may account for the pathogenesis of ampulla cardiomyopathy among postmeno-pausal women. Transient impairment of coronary mi-crocirculation  Several reports have demonstrated that the coronary vasodilatory response is impaired in patients with ampulla cardio-myopathy.10,11 Ako et al.10 showed that the coronary flow reserve was reduced in the acute phase of ampulla cardiomyopathy. Yanagi11 also demonstrated impairment of the coronary vasodilatory reserve in the acute phase, suggesting microcirculatory dysfunction. In our case, CFR was severely attenuated in the acute phase. This suggests that impairment of the microcirculation may play a contributory role in the pathophysiol-ogy of ampulla cardiomyopathy.  In the present case, the serial measure-ment of CFR revealed gradual improvement toward a normal level; however, the CFR was at a subnormal level even 6 months af-ter the left ventricular wall motion returned to normal. Reis et al.12 reported that coro-nary microvascular dysfunction is highly prevalent among postmenopausal women even in the absence of coronary artery dis-ease, demonstrating that postmenopausal women had subnormal CFR suggestive of microvascular dysfunction. In our case, the CFR was subnormal even in the chronic phase. This suggests that the intrinsic im-pairment of the vasodilatory capacity and further deterioration of the microcircula-tory damage may have contributed to the occurrence of ampulla cardiomyopathy in the present patient.  In conclusion, we experienced a case of ampulla cardiomyopathy with left ventricu-lar outow obstruction successfully treated with aβ-blocker. Both intrinsic hypersen-sitivity toβ-receptors and impairment of the coronary microcirculation may have accounted for the pathogenesis of transient apical ballooning associated with left ven-tricular dynamic obstruction in the present postmenopausal patient. References1)  Satoh H, Tateish H, Uchida T, Dote K, Ishihara M. Tako-tsubo like cardiomy-opathy due to multivessel spasm. In: Kodama K, Haze K, Hon M, editors. Clinical aspect of myocardial injury: From ischemia to heart failure. To-kyo: Kagakuhyoronsha Co; 56-64 (in Japanese) 1989.2)  Tsuchihashi K, Ueshima K, Uchida T et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarc-tion. Angina Pectoris-Myocardial In-farction Investigations in Japan. J Am Coll Cardiol 38(1):11-8, 2001. 3)  Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment

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