PMC3425231_01
A 12-lead electrocardiogram (ECG) (a) shows ST-segment elevation and deep T-wave inversions in the V2-V3 and DII, DIII and aVF too in the acute onset. (b) Two months later
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F2
T-waves deep and symmetric in V4-V6 and QT interval within normal limits [Figure 2a]. The cardiac biomarkers of heart damage (creatine kinase CK and its isoenzyme CK-MB) were only very slightly elevated in serial measures. All of the ECG abnormalities returned to the baseline in 7 days [Figure 2b] there was a total recovery in global and regional left ventricular function, evaluated by echocardiography [Figure 3c].
Echocardiography images (Two-chamber long axis) (a-b) Acute onset (a) End-diastole (b) End-systole (c) Two months later
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F3
Echocardiography revealed a reduction of the left ventricular ejection fraction (LVEF), akinesis of the apical and distal anterior wall with hypercontractility of the basal wall producing the apical ballooning configuration of the LV in systole, typical of this disorder [Figure 3a-b]. All of the ECG abnormalities returned to the baseline in 7 days [Figure 2b] there was a total recovery in global and regional left ventricular function, evaluated by echocardiography [Figure 3c].
Coronary angiography (a) Left coronary (b) Right coronary. There is no epicardial coronary stenosis
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F4
The patient underwent emergency cardiac catheterization, which disclosed no significant epicardial coronary artery stenosis [Figure 4].
Tc99 MIBI-SPECT images. Early images (a, c) show decreased myocardial perfusion in distal anterior and lateral wall, and apex. (b, d) after complete recovery
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F5
Perfusion abnormalities in the left ventricular apex, lateral and anterior walls were documented [Figure 5a-c].
Bull-eye and thickening images. (a-c) Acute once. (b-d) Two months later
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F6
Thickening and contractility were reduced in these segments [Figure 6a-c].
Gated-SPECT. Synchronism, (a) Acute onset. (b) Two months later
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F7
Toolbox. There was an increase in peak phase degree (225), phase SD degree (49.1), and in the phase histogram bandwidth degree (150) [Figure 7a]. Perfusion defects and synchronism also disappeared in the same period, assessed by nuclear medicine. [5b, d and Figure 7b].