J Cardiovasc Ultrasound.  2010 Mar;18(1):16-20. 10.4250/jcu.2010.18.1.16.

Acute Coronary Syndrome Mimicking Atypical Stress-Induced Cardiomyopathy in a Patient with Panhypopituitarism

• Park CS
• Yun YS
• Kim YJ
• Kim MJ
• Cho EJ
• Ihm SH
• Jung HO
• Jeon HK
• Kim HY
• Youn HJ

• KMID: 1457200
• DOI: http://doi.org/10.4250/jcu.2010.18.1.16

Abstract

Stress-induced cardiomyopathy is frequently confused with acute coronary syndromes. We encountered a 64-year old female patient with panhypopituitarism initially suspected as atypical stress-induced cardiomyopathy due to her history and initial echocardiographic findings. She was finally diagnosed as non ST-segment elevation myocardial infarction based on the findings of coronary angiogram, intravascular ultrasound and subsequent echocardiogram.

Keyword

Stress-induced cardiomyopathy; Acute coronary syndrome; Echocardiography

MeSH Terms

Acute Coronary Syndrome
Cardiomyopathies
Echocardiography
Female
Humans
Hypopituitarism
Myocardial Infarction

Figure

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  Fig. 1 Electrocardiogram on admission (A) shows T wave inversion in II, III, aVF and chest leads. Follow-up electrocardiogram the next day (B) demonstrates normalization of T wave inversion, but ST segment depression remained in chest leads.

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  Fig. 2 Echocardiogram obtained upon admission shows basal dyskinesia with sparing of the apical wall motion on apical four-chamber view. (A: end diastole, B: end systole). Follow-up echocardiogram shows almost no interval change after 5 days. (C: end diastole, D: end systole). Echocardiogram obtained 5 weeks later demonstrates recovery of regional left ventricular function, except basal inferoseptal portion (E: end diastole, F: end systole).

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  Fig. 3 Magnetic resonance imaging shows empty sella (arrow) and displaced pituitary stalk.

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  Fig. 4 A: Basal dyskinesia with sparing of the apical wall motion is demonstrated by bull's eye display showing peak systolic longitudinal strain of the left ventricle in automated functional imaging of follow-up echocardiogram performed on 5th hospital day. B: Dyskinesia remains, especially on basal inferoseptal wall of left ventricle, as is demonstrated by follow-up echocardiogram 5 weeks after initial presentation.

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  Fig. 5 A: Coronary angiogram shows significant stenosis of left anterior descending artery. B: Mild stenosis of right coronary artery is also observed. C: Intravascular ultrasound shows atheroma plaque resulting obstructive stenosis of LAD. D: Percutaneous coronary intervention is performed on the left anterior descending artery and there is no residual stenosis.

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