Chest
Volume 114, Issue 1, July 1998, Pages 98-105
Journal home page for Chest

Clinical Investigations
Reversible Myocardial Contraction Abnormalities in Patients With an Acute Noncardiac Illness

https://doi.org/10.1378/chest.114.1.98Get rights and content

Study objectives

Reversible myocardial contraction abnormalities are usually observed in patients with acute ischemic syndromes caused by coronary artery disease. In this study, we report the occurrence of reversible anterior-apical contraction abnormalities in patients with an acute noncardiac illness.

Setting

This was a retrospective study of 22 patients with the following characteristics: (1) hospitalization for an acute noncardiac illness; (2) appearance of deep T-wave inversion in the precordial leads of the ECG; and (3) presence of an anterior wall motion abnormality on an echocardiogram. Standard clinical information was collected together with results of serial ECGs, echocardiograms, and coronary angiograms.

Results

The primary diagnoses for the 22 acutely ill patients included CNS injury (n=6); sepsis (n=3); acute pulmonary disease (n=3); drug overdose or metabolic abnormality (n=7); and post noncardiac surgery (n=3). An initial echocardiogram revealed an anterior apical wall motion abnormality. At follow-up, all patients had progressive improvement in anterior wall motion with return of normal wall motion in 16 patients (73%). All patients evolved deep T-wave inversion (average, 7.8 mm) and QT interval lengthening in the precordial leads. Coronary angiography revealed a significant stenosis in the likely culprit artery (left anterior descending) in only one patient.

Conclusion

A reversible cardiac contraction abnormality of the anterior wall and apex of the left ventricle can complicate the clinical course of critically ill patients in the absence of significant coronary artery disease. This phenomenon is associated with striking T-wave inversion and QT interval lengthening. Mechanisms other than myocardial ischemia may lead to the occurrence of reversible regional myocardial contraction abnormalities.

Section snippets

Materials and Methods

Between 1993 and 1996, we identified 22 patients who shared the following characteristics: (1) hospitalization for an acute noncardiac illness; (2) appearance of deep (≥3.0 mm) T-wave inversion in the precordial leads of the ECG (Fig 1); and (3) presence of a presumed new anterior contraction abnormality on an echocardiogram. All patients were identified as a consequence of a request for cardiac consultation by the medicine or surgery service. Data were primarily collected retrospectively and

Patient Characteristics

The study group comprised 22 acutely ill patients. The baseline characteristics of these patients are presented in Table 1. The average age was 56.3 years (range, 19 to 83 years) and 18 patients (82%) were women. Each patient was hospitalized with an acute noncardiac illness (Table 1). The primary diagnoses included CNS injury (n=6); sepsis (n = 3); acute pulmonary disease (n=3); drug overdose or metabolic abnormality (n=7); and post noncardiac surgery (n=3). Cocaine use was not a factor in any

Discussion

This study describes the occurrence of prolonged but reversible anterior-apical contraction abnormalities in critically ill patients. None of the patients was hospitalized because of a primary cardiac illness. The cardiac injury observed in these patients shares many similarities with the phenomenon of myocardial stunning. First, the injury was regional. Second, there was significant improvement of regional wall motion over a period of days. In most patients, complete recovery of regional wall

Addendum

Since this manuscript was submitted, Parin et al24 have reported two cases of transient cardiomyopathy triggered by intense emotional stress. The clinical features and ECG findings reported are similar to those described herein.

Acknowledgments

Rosie Robinson, MaryAnn Murakami, and Maureen Adams are responsible for expert preparation of this manuscript. We thank Dr. Howard Burchell for his encouragement and interest in this report.

References (24)

  • OkadaM et al.

    Clinical implications of isolated T-wave inversion in adults: electrocardiographic differentiation of the underlying causes of this phenomenon

    J Am Coll Cardiol

    (1994)
  • BraunwaldE et al.

    The stunned myocardium: prolonged post-ischemic ventricular dysfunction

    Circulation

    (1982)
  • Cited by (120)

    View all citing articles on Scopus
    View full text