Transient Left Ventricular Aneurysm and Hypertrophy Accompanied by Polymorphic Ventricular Tachycardia in a Patient Suspected of Acute Myocarditis.

Abstract

EVERSIBLE causes of myocardial dysfunction have a wide spectrum of pathophysiologies: coronary vasospasm, coronary thromboembolism, myocardial stunning, neurohumoral abnormalities, acute myocarditis, severe prolonged anemia, tachycardia-induced cardiomyopathy, and other causes.1-6) Sometimes the clinical findings mimic acute myocardial infarction, which may make an exact diagnosis difficult. We describe here an unusual case of transient ventricular aneurysm that showed torsades de pointes (TdP) and ischemic changes on SUMMARYA 75-year-old woman presented with recurrent ventricular tachycardia (VT) compatible with torsades de pointes (TdP) based on sinus bradycardia and QT prolongation. Previously she had received pirmenol, at a serum concentration within therapeutic range, for her paroxysmal atrial fibrillation. Emergent cardiac catheterization identified a ventricular aneurysm of the anteroapical and inferior wall along with angiographically normal coronary arteries. A right ventricular endomyocardial biopsy revealed postmyocarditic change. The left ventricular contraction improved after 5 weeks of conservative treatment. A follow-up echocardiogram revealed transient thickening of partial left ventricular wall consistent with the segment of the aneurysm. Several months later, almost all abnormal findings had improved except for sustained deep negative T waves in precordial leads. Acute myocarditis was primarily suspected as the cause of her clinical presentation. (Jpn Heart J 2000; 41: 97-102)

Left Ventricular Aneurysm Presenting as Bidirectional Ventricular Tachycardia

“…We believe that the patient had had a myocardial infarction that led to ventricular aneurysm formation and then to the subsequent arrhythmia. Although ventricular aneurysms have been known to provide a focus for both monomorphic and polymorphic ventricular tachycardia, 4 to our knowledge, no reports of an aneurysm being the site of origin of a bidirectional ventricular tachycardia have been published. Cases have been reported, however, of bidirectional ventricular tachycardia occurring shortly after myocardial infarction 5 or in association with infiltrative cardiomyopathies such as sarcoidosis.…”

Reversible Left Ventricular Systolic Dysfunction-Reversibility of Coronary Microvascular Abnormality.

“…Reversible left ventricular dysfunction is observed in patients under strong emotional stress or in patients with subarachnoid hemorrhage. [1][2][3][4][5][6][7] The exact mechanism of this phenomenon, however, is still unknown.…”

“…1) Apical left ventricular dysfunction without any lesions in the corre- sponding coronary arteries is reported to occur in many clinical circumstances, especially after strong emotional stress or in subarachnoid hemorrhage. [1][2][3][4][5][6][7] The pathogenesis of the apical left ventricular dysfunction is thought to be a result of epicardial vasospasm, 8) myocarditis, 2) catecholamine cardiotoxicity, 9) cardiomyopathy, 5) or microvascular dysfunction. 7) The exact mechanism of this transient left ventricular dysfunction remains uncertain.…”