急性心筋梗塞に類似した特異的なstunned myocardiumを認めた1例

A Case of Atypical Stunned Myocardium Similar to Acute Myocardial Infarction

　患者は78歳，女性．胸痛にて来院し，硝酸薬投与にて改善なく，心電図上前胸部誘導を中心に広範囲な持続するSTの上昇を認めた．急性前壁中隔心筋梗塞を疑い冠動脈造影を施行したが，有意狭窄所見および血栓像，攣縮像は認められなかった．左室造影所見は心尖部を中心とした収縮能の低下と心基部の過収縮を認め，いわゆる“たこつぼ様”を呈していた．翌朝には胸痛は完全消失し，その後は再発作の出現は認められず，経過中の心筋逸脱酵素の上昇はごく軽度であった．慢性期の左室造影所見では左室壁運動は正常化しており，左右冠動脈造影も異常所見を認めなかった．同時に施行したアセチルコリン負荷試験では冠攣縮は誘発されず陰性であった．急性心筋梗塞に類似した発症経過で冠動脈造影にて異常所見を認めず，急性期に特異的な“たこつぼ様”の左室収縮異常を示し，早期にその収縮異常が改善する症例が報告されており，われわれも同様と思われる症例を経験したため報告する．

A 78-year-old woman was admitted to the hospitalbecause of chest pain and was treated with nitroglycerinbut the symptoms did not improve. Electrocardiographyof the anterior chest lead revealed ST elevation. Acutemyocardial infarction was suspected.

Coronary angiography was performed but abnormalfindings were not seen. Left ventriculography showeddyskinesis at the apex cordis and hyperkinesis at thebase. Chest pain disappeared the next day and furtherattacks did not occur. There was a minimal rise inmyocardial deviation enzyme. Left ventriculographyperformed during the chronic stage showed intact move-ment of the left ventricle. Coronary angiography wasnormal and the acetylcholine load test was also nega-tive. There was a report of a case with similar onset andcourse and which was diagnosed as acute myocardialinfarction, with no abnormal findings of coronary angio-graphy and with specific abnormal movement of the leftventricle which improved at a very early stage. Wereport our encounter with this case.