Reversible left ventricular dysfunction associated with Guillain-BarrŽ syndrome: An expression of catecholamine cardiotoxicity?

Kanji Iga, Yoshihiro Himura, Chisato Izumi, Tadashi Miyamoto, Kazuhisa Kijima, Hiromitsu Gen, Takashi Konishi,

Summary

The patient was a 76-year-old female with a history of Guillain-BarrŽ syndrome 3 years earlier; ST segments of electrocardiogram were elevated in association with reversible left ventricular dysfunction. Left ventrioculogram and coronary angiograms were normal and ergonovine test was negative during the chronic period of Guillain-BarrŽ syndrome. She was hospitalized again because of recurrence of Guillain-BarrŽ syndrome. Two days later, ST segments were elevated in V2 through V5 which prompted us to perform cardiac catheterization, although she did not complain of any chest symptoms. A large akinetic area was found mainly around the apex on left ventriculography despite no coronary stenoses. Peak Creatine kinase and C-reactive protein were 400 IU/ml and 3.5mg/dl respectively. Left ventricular dysfunction was normalized in one week.

During the acute phase of cardiac episode, plasma norepinephrine and epinephrine were 1340pg/ml and 112pg/ml, respectively. I123 metaiodobenzylguanidine myocardial scintigram 3 weeks after the episode showed an extensive apical defect which was improved markedly 3 months later.

We think that this reversible left ventricular dysfunction was due to synergistical toxic effect of mildly increased catecholamine and transiently damaged sympathetic nerve endings of the myocardium presumably by Guillain-BarrŽ syndrome.