Prominent isovolumic relaxation flow in a patient with cardiac tamponade.

We present herein the case of a 72-year-old man who presented with orthopnea and was diagnosed with cardiac tamponade due to carcinomatous pericarditis. Pulsed Doppler echocardiogram showed prominent isovolumic relaxation flow (IVRF) directed from the cardiac base toward the apex. Such flow is rare in pericardial effusion and may be due to enhanced early diastolic untwisting, sphericalization of apex, and restriction of wall motion by epicardial fibrous tissue. We describe herein a rare case of prominent IVRF with interesting underlying mechanisms.

Coronary spasm as a cause of takotsubo cardiomyopathy and intraventricular obstruction.

A 79-year-old man presented to the emergency room because of chest pain on 3 successive mornings. An electrocardiogram (ECG) showed ST segment elevation in leads II, III, and aVF. Laboratory findings including cardiac enzymes, were within normal limits, except a positive result for the troponin T test. Two-dimensional echocardiography revealed akinesis of the left ventricular apex and hyperkinesis of the basal wall. Doppler echocardiography revealed a significant subaortic pressure gradient. Emergent coronary angiography showed no significant coronary artery stenosis, but the ergonovine test induced a right coronary artery spasm with exaggeration of the ST segment elevation in II, III, and aVF leads. The computed tomography performed 2 weeks later showed normal left ventricular wall motion with sigmoid septum. The patient was diagnosed with takotsubo cardiomyopathy and intraventricular obstruction due to coronary spasm; he was treated with calcium channel blockers and nitrates. This case suggests the importance of differential diagnosis of the pathogenesis of takotsubo cardiomyopathy.