Metabolic evidence of myocardial stunning in takotsubo cardiomyopathy: a positron emission tomography study.

my viab Several case studies of acute transient left ventricr apical ballooning without significant coronary ry disease (takotsubo cardiomyopathy) have been orted. The pathophysiologic mechanism of this drome is believed to be related to catecholamineuced stunning of the apical myocardium. Definitive of, however, is lacking. Here we report a case of transient apical ballooning which metabolic imaging with positron emission ography (PET) revealed profoundly reduced fluo-18 fluorodeoxyglucose (FDG) uptake in the balned apical wall with relatively normal perfusion, a ern consistent with myocardial stunning. This perfu-metabolism pattern normalized, as did contractility. Case report. A 52-year-old white woman preted to the emergency department 8 hours after the te onset of chest pain and shortness of breath. ptoms started and then waxed and waned after an tional argument with her husband. She denied toco, alcohol, or drug use. Her past medical history was y significant for hyperlipidemia, for which she had n taking atorvastatin. On arrival, her blood pressure 77/50 mm Hg and her heart rate was 88 beats/min. ular venous distension was appreciated in the sitting ition, and respiratory crackles were heard bilaterally. murmurs, rubs, or gallops were appreciated. The trocardiogram revealed mild ST elevation in leads II, and aVF with diffuse T-wave inversion and QT longation (Figure 1). A chest radiograph was consiswith bilateral pulmonary parenchymal congestion. ergent coronary angiography revealed normal coroy arteries. Left ventriculography showed distal ante, apical, and distal inferior akinesis with hyperkinesis the remaining walls (Figure 2). The level of serum