Possible association of influenza A infection and reverse takotsubo syndrome

We present a case of reverse takotsubo syndrome (rTS) in a 68-year-old woman who presented with acute chest pain and flu-like symptoms. She was found to have elevated troponin and abnormal ECG. Urgent coronary angiogram revealed non-obstructive mild coronary artery disease of the left anterior descending artery. Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. Nasal viral PCR was positive for Influenza A. The diagnosis was confirmed with repeat echocardiogram 2 weeks later revealing resolution of regional wall motion abnormalities. rTS is a type of TS, mimicking acute coronary syndrome. It is seen in younger patients and often occurs with intense emotional and physical stress. Though many triggers have been reported, rTS associated with influenza A has not been previously documented.

Functional role of myocardial electrical remodeling in diabetic rabbits

The objective of the study was to investigate the role of electrical remodeling of the ventricular myocardium in hemodynamic impairment and the development of arrhythmogenic substrate. Experiments were conducted with 11 healthy and 12 diabetic (alloxan model, 4 weeks) rabbits. Left ventricular pressure was monitored and unipolar electrograms were recorded from 64 epicardial leads. Aortic banding was used to provoke arrhythmia. The diabetic rabbits had prolonged QTc, with activation–recovery intervals (surrogates for repolarization durations) being relatively short on the left ventricular base and long on the anterior apical portions of both ventricles (P < 0.05). In the diabetic rabbits, a negative correlation (–0.726 to –0.817) was observed between dP/dtmax, dP/dtmin, and repolarization dispersions. Under conditions of systolic overload (5 min), tachyarrhythmias were equally rare and the QTc and activation–recovery intervals were shortened in both groups (P < 0.05), whereas QRS was prolonged in the diabetic rabbits only. The repolarization shortening was more pronounced on the apex, which led to the development of apicobasal and interventricular end of repolarization gradients in the healthy animals, and to the flattening of the repolarization profile in the diabetic group. Thus, the diabetes-related pattern of ventricular repolarization was associated with inotropic and lusitropic impairment of the cardiac pump function.

“Rigid body rotation” of the left ventricle in hypoplastic right-heart syndrome: a case from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Left ventricular twist results from the movement of two orthogonally oriented muscular bands of the helical myocardial structure, with a consequent clockwise rotation of the left ventricular base and counterclockwise rotation of the left ventricular apex. To the best of the authors’ knowledge, this is the first time that left ventricular “rigid body rotation”, the near absence of left ventricular twist in hypoplastic right-heart syndrome, has been demonstrated.

Imaging systolic and diastolic heart murmurs in hypertrophic cardiomyopathy

Muscular obstruction in hypertrophic cardiomyopathy can occur not only in systole, but also in diastole. Here we report a case of hypertrophic cardiomyopathy in a middle-aged lady: echocardiography and cardiovascular magnetic resonance confirmed the diagnosis of hypertrophic cardiomyopathy with significant systolic and diastolic midventricular obstruction, corresponding to the murmurs audible in mid-systole and early-diastole respectively. Moreover, the mid-systolic murmur was clearly distinguishable from the mitral regurgitation murmur, which was audible throughout systole (pan-systolic) and likely related to systolic anterior motion of the mitral chords; similarly, the early-diastolic heart murmur due to diastolic obstruction was better audible at the apex and clearly distinguishable from common diastolic murmurs due to aortic regurgitation. Echocardiography (with Doppler recordings) and magnetic resonance (with turbulence flows at steady state free precession imaging) allowed a detailed visualization of each audible murmur (systolic obstruction, mitral regurgitation, diastolic obstruction). In particular, while systolic obstruction has been extensively studied in hypertrophic cardiomyopathy, only very few reports about diastolic obstruction exist, describing either a normodirected midventricular diastolic obstruction (forward flow) similar to this case or a paradoxical midventricular diastolic obstruction (backward flow) in patients with an apical aneurysm emptying during early diastole into the left ventricular base through a narrow midventricular channel. Whether diastolic obstruction implies worse prognosis or requires specific treatment, deserves further research.