IMAGES IN CARDIOLOGY
Coeur DouloureuxTransient Midventricular Ballooning Syndrome Precipitated by Trigeminal Neuralgia
Reza Sanai, MD*,
Ramesh Mazhari, MD*,
Robert K. Zeman, MD and
Brian G. Choi, MD, MBA*
* Division of Cardiology, The George Washington University, Washington, DC
Department of Radiology, The George Washington University, Washington, DC
Manuscript received March 4, 2009;
accepted March 12, 2009.
A 65-year-old woman with history of trigeminal neuralgia presented with left facial tic douloureux soon followed by substernal chest pain. Electrocardiogram demonstrated T-wave inversions in leads I and aVL, and an initial troponin I of 2.58 ng/ml led to cardiac catheterization. Coronary angiography was normal, but left ventriculogram revealed midanterior and inferior wall dyskinesis (A and B, arrowheads pointing to dyskinetic segments, Online Video 1) consistent with midventricular ballooning syndrome (1). Cardiovascular magnetic resonance imaging using a steady-state cine sequence completed on hospital day 2 similarly demonstrated midventricular ballooning (Online Video 2), but delayed hyperenhancement was not detected in the midventricle or elsewhere on post-contrast images (C).
Catecholamine-mediated myocardial stunning is a presumed mechanism for this syndrome. This presentation supports this hypothesis. Attacks of trigeminal neuralgia have long been noted to be associated with catecholamine surge (2). In this case, an episode of tic douloureux ironically led to a pain of the heart, a coeur douloureux.
 |
References
|
|---|
1. Hurst RT, Askew JW, Reuss CS, et al. Transient midventricular ballooning syndrome: a new variant J Am Coll Cardiol 2006;48:579-583.[Abstract/Free Full Text]2. Strittmatter M, Grauer MT, Fischer C, et al. Autonomic nervous system and neuroendocrine changes in patients with idiopathic trigeminal neuralgia Cephalalgia 1996;16:476-480.[CrossRef][Web of Science][Medline]
|
Top
References