拡張型心筋症で加療中に発症したcarvedilolが有効と考えられたたこつぼ型心筋障害の１例

A Rapidly Improved Case of Ampulla Cardiomyopathy Pretreated with Carvedilol for Dilated Cardiomyopathy

要旨

患者は59歳，男性．2002年4月うっ血性心不全の入院歴があり，拡張型心筋症としてcarvedilol 5mg/日で外来コントロール良好であった．同年10月，パチンコ中に前胸部痛が持続するため5時間後に救急搬入された．搬入時V₁～V₃でQS，II，III，_aV_F，V₄～V₆に陰性T波，血漿norepinephrineは軽度上昇していた．緊急冠動脈造影で有意狭窄は認めず，左室造影では前壁から心尖部のballooningと心基部の過収縮を認めた(駆出率＝28％)．Carvedilol内服を継続し，翌日にはV₁～V₄のR波が増高し，壁運動は心尖部の一部を除き正常化した(駆出率＝48％)．¹²³I-β-methyliodopentade-caoic acid心筋シンチはほぼ正常の集積を，¹²³I-meta-iodobenzyl-guanidine心筋シンチは心不全入院時より著明に改善していた．本例は過度の興奮で発症したたこつぼ型心筋障害と考えられたが，carvedilolが発症後の良好な経過に重要な役割を果たしたと考えられた．

Summary

A 59-year-old man was admitted to our hospital with complaints of continuous chest pain of 5 hours while playing pachinko in October 2002. He had a history of congestive heart failure due to dilated cardiomyopathy 6 months before, and was treated with carvedilol (5mg/day). An electrocardiogram showed negative T in leads I, II, III, aVF, V₄～V₆ and QS in leads V₁～V₃. Laboratory data were normal except for a slight increase in noradrenaline. Emergent coronary angiography showed no epicardial artery stenosis, but ventriculography confirmed the presence of apico-anterior ballooning with basal hypercontraction(ejection fraction(EF)28%). Oral carvedilol administration was again begun and the electrocardiographic changes improved (regression of R wave in V₁～V₃) and wall motion abnormalities almost disappeared(EF, 48%) within two days. ¹²³Iβ-methyliodopentadecaoic acid(BMIPP)myocardial scintigraphy revealed almost normal uptake. ¹²³I-meta-iodobenzyl-guanidine(MIBG)findings showed a slight defect in the apico-inferior wall but this had greatly improved in comparison with those in April 2002. Emotional stress has been known to induce ampulla cardiomyopathy as recognized in our case. Pretreatment with carvedilol was considered to have played an important role in the improvement of this patient＆apos;s ampulla cardiomyopathy.