Kawabata Mihoko, Kubo Ichiro, Suzuki Kou, Terai Tomoko, Iwama Touru, Isobe Mitsuaki
Department of Cardiology, Bokutou Metropolitan Hospital, Tokyo, Japan.
Circ J. 2003 Aug;67(8):721-4. doi: 10.1253/circj.67.721.
A 66-year-old man developed a fever and had a syncopal attack during treatment with imipramine and amantadine for depression and Parkinson's disease. His muscular enzyme levels were very high, so he was diagnosed with incomplete syndrome malin and given hydration therapy. The electrocardiogram recorded an ST segment elevation like acute myocardial infarction in most leads, and the echocardiogram revealed left ventricular dysfunction with severe hypokinesis to dyskinesis of the anterior and apical wall regions, and hyperkinesis of the basal wall. One month from onset, the left ventricular contractility had not changed despite normal coronary arteries. Thallium-201((201)Tl) myocardial scintigraphy showed a perfusion defect and there was no accumulation of iodine-123((123)I) metaiodobenzylguanidine (MIBG) in the entire apex of the heart. Left ventricular function returned to normal and repeat (201)Tl scintigraphy showed recovery by the 4th month. However, there was still an absence of cardiac MIBG uptake. There are a number of reports from Japan of a syndrome demonstrating such reversible left ventricular dysfunction, called 'tako-tsubo cardiomyopathy', but the present case is the first to be associated with syndrome malin. A coronary microvascular abnormality and cardiac sympathetic denervation probably both play an important role in tako-tsubo cardiomyopathy.
一名66岁男性在使用丙咪嗪和金刚烷胺治疗抑郁症和帕金森病期间出现发热并发生晕厥。他的肌肉酶水平非常高，因此被诊断为不完全性恶性综合征并接受了补液治疗。心电图显示大多数导联ST段抬高，类似急性心肌梗死，超声心动图显示左心室功能障碍，前壁和心尖壁区域严重运动减弱至运动障碍，基底部壁运动亢进。发病1个月后，尽管冠状动脉正常，但左心室收缩力没有改变。铊-201（（201）Tl）心肌闪烁显像显示灌注缺损，整个心尖部未发现碘-123（（123）I）间碘苄胍（MIBG）摄取。左心室功能恢复正常，重复（201）Tl闪烁显像显示第4个月时恢复。然而，心脏MIBG摄取仍然缺失。日本有许多关于一种表现为这种可逆性左心室功能障碍的综合征的报道，称为“应激性心肌病”，但本病例是首例与恶性综合征相关的病例。冠状动脉微血管异常和心脏交感神经去神经支配可能在应激性心肌病中都起重要作用。
