Transient Segmental Asynergy of the Left Ventricle of Patients with Various Clinical Manifestations Possibly Unrelated to the Coronary Artery Disease
Kanji Iga MD, Kenjiro Hori MD, Katuji Kitaguchi MD,
Tadashi Matsumura MD, Hiromitu Gen MD, Go Tomonaga MD
and Toshitake Tamamura MD
Abstract
Eight cases of transient reversible segmental asynergy of the left
ventricle thought not to be related to coronary artery lesions are reported.
Three cases were associated with inflammatory reactions of unknown origin,
and one each with lactic acidosis, abdominal surgery, hypoglycemia, tetanus
and pneumonia. None of the patients had symptoms suggestive of ischemic
heart disease before or after these episodes. Electrocardiograms before
these episodes were all normal. Two-dimensional echocardiography was performed
to evaluate abnormal electrocardiograms. Coronary angiography was performed
in 4 of 8 cases and was normal in all 4 cases; 2 done emergently and 2 non-emergently.
Two ergonovine tests were negative. Left ventricular wall motion abnormalities,
present mainly at the apex of the left ventricle, returned to normal in
one to 4 weeks. Giant negative T waves in the chest leads during this recovery
period were characteristic electrocardiographic features and normalized
in 6 weeks on average. We believe that these episodes were not related
to ischemia due to coronary artery disease, but to some metabolic humoral
factors. An excellent prognosis can be expected if these abnormal metabolic
circumstances can be resolved.