PMC2626695_01
A 66-year-old woman with transient left ventricular apical ballooning.. A. The initial echocardiogram shows T-wave inversion in leads V3 through V6, and Q-wave in leads V4 through V6.. B. The aortogram reveals left ventricular apical and mid-ventricular akinesis and basal hyperkinesis.. C. The conventional coronary angiogram shows no obstruction of the right and left coronary arteries.. D. The cine MR images in a four chamber view show severe hypokinesis of the left ventricular apical and mid-ventricle, which was slightly improved compared to that of the aortogram (B).. E. The first-pass perfusion MR images in a short axis view at the apical level show no perfusion abnormality of the myocardium. The upper row images are not enhanced images and the lower row images are maximally enhanced images of the myocardium.. F. The contrast-enhanced delayed images in a short axis view show no abnormal enhancement of the myocardium.. G. The coronary MR angiograms show no significant stenosis of the left and right epicardial coronary arteries.
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F1
T-wave inversion in leads V3 through V6, and Q-wave in leads V4 through V6 (Fig. 1A), and this was all newly developed compared to the ECG taken one year previously. The troponine-T, CK-MB and CK levels were slightly elevated to 0.565 ng/mL (normal range: 0-0.1 ng/mL), 10.98 ng/mL (normal range: 0-5 ng/mL), and 164 IU/L (normal range: 32-135 IU/L), respectively. An aortogram showed the same findings as echocardiography, that is, akinesis from the mid to apical left ventricle with sparing of the basal segments (Fig. 1B). However, a coronary angiography showed no significant stenosis of the epicardial coronary arteries (Fig. 1C). There was severe hypokinesis from the mid to apical left ventricle with sparing of the basal segments (Fig. 1D). There was no perfusion abnormality (Fig. 1E) or hyperenhancement of the myocardium (Fig. 1F). Coronary MR angiography showed no significant stenosis of the major epicardial coronary arteries (Fig. 1G).