Demonstration of sympathetic nerve innervation in a patient with takotsubo cardiomyopathy using single-photon emission CT

Description

A 16-year-old male patient with anorexia nervosa was admitted to our hospital because of unconsciousness. He was in hypoglycaemic shock, with a serum glucose level of 40 mg/dL, and recovered consciousness after a venous injection of glucose. The patient's systolic blood pressure remained <70 mm Hg after he recovered consciousness. A 12-lead ECG showed Q waves and ST segment elevation in the precordial leads, and echocardiography showed hypokinesis of the midventricle and apex. Next, we performed coronary angiography, which revealed the absence of stenosis of the coronary arteries. Left ventriculography showed findings typical of takotsubo cardiomyopathy, apical ballooning with akinesis of the midventricle and apex and hyperkinetic basal segments (figure 1). 201Tl and iodofiltic acid (123)I-dual cardiac single-photon emission CT (SPECT) (figure 2A,B) at 1 week showed the absence of perfusion defect and fatty acid metabolism abnormality at the apex. Metaiodobenzylguanidine cardiac SPECT (figure 2C)...

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