PMC8461009_01
First electrocardiogram and echocardiogram after the onset of the clinical manifestations (A). The electrocardiogram shows sinus rhythm with 100 rpm, PR 0.14 s, QRS 0.08 s, QT/QTc 320/422 ms and diffuse alterations in ventricular repolarization with negative T waves in precordial leads (V4-V6), D2, D3 and aVF (B1-B4). The echocardiogram shows a diffusely hypokinetic left ventricle with an ejection fraction of 34%. Left ventricular inner dimension diastole 50 mm (Z score +2.3), left ventricular inner dimension systole 39 mm (Z score +4.25), left posterior ventricular wall diastole 6.6 mm (Z score -0.23), interventricular septum diastole 5.5 mm (Z score -1.22), right ventricular inner dimension diastole 14 mm (Z score +0.20) [Z score is derived from Kampman et al. ] (B1,B2). Moderate mitral valve regurgitation (left ventricular delta Pressure/delta Time 699 mmHg/s) (B3). Left and right coronary artery originating from left and right Valsalva sinus, respectively (B4).
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F1
An electrocardiogram (ECG) showed sinus rhythm with ventricular repolarization abnormalities in the inferior lateral wall (Figure 1). Moreover, the echocardiographic study demonstrated global left ventricular (LV) hypokinesia and dilatation with preserved right ventricular function (Figure 1).
(A) Cardiac contrast-enhancement magnetic resonance imaging demonstrates an increase of T2 signal on anterior left ventricular wall. (B1-B4) Coronary computed tomography reveals a right dominant coronary artery (B1), left common trunk coronary artery (B2), left circumflex coronary artery (B3) and left anterior descending (LAD) coronary artery (B4) without any dissection, lumen obstruction or anatomical variants. A tract of LAD coronary artery runs through the width of the myocardial wall for 12.3 mm and with a parietal thickness of 1.4 mm (B4).
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F2
Oedema was noticed on the anterior ventricular wall (Figure 2), possibly consistent with reversible myocardial injury potentially related to myocardial ischemia, while no signs of fibrosis were demonstrated after gadolinium enhancement. However, it was clearly observed myocardial bridge of a tract of the left anterior descending (LAD) coronary artery (Figure 2).
Trend of troponin, NT-proBNP (A) and ejection fraction (B) from the admission to the discharge of the patient. NT-proBNP, N-terminal-prohormone B-type natriuretic peptide.
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F3
A daily cardiac evaluation revealed a complete normalization of ECG and a complete recovery in the cardiac function 72 hours from the beginning of the clinical manifestations, along with a marked reduction in CK-MB, troponin and NT-proBNP, at discharge, 6 days after admission (Figure 3), while the patient was in good clinical condition, in absence of drug therapy.