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Coeur Douloureux
Journal of the American College of Cardiology © 2009 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 54, No. 15, 2009 ISSN 0735-1097/09/$36.00 doi:10.1016/j.jacc.2009.03.088
IMAGES IN CARDIOLOGY
Coeur Douloureux Transient Midventricular Ballooning Syndrome Precipitated by Trigeminal Neuralgia Reza Sanai, MD,* Ramesh Mazhari, MD,* Robert K. Zeman, MD,† Brian G. Choi, MD, MBA* Washington, DC
From the *Division of Cardiology and †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 – 83.
2. Strittmatter M, Grauer MT, Fischer C, et al. Autonomic nervous system and neuroendocrine changes in patients with idiopathic trigeminal neuralgia. Cephalalgia 1996;16:476–80.
Vol. 54, No. 15, 2009 ISSN 0735-1097/09/$36.00 doi:10.1016/j.jacc.2009.03.088
IMAGES IN CARDIOLOGY
Coeur Douloureux Transient Midventricular Ballooning Syndrome Precipitated by Trigeminal Neuralgia Reza Sanai, MD,* Ramesh Mazhari, MD,* Robert K. Zeman, MD,† Brian G. Choi, MD, MBA* Washington, DC
From the *Division of Cardiology and †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 – 83.
2. Strittmatter M, Grauer MT, Fischer C, et al. Autonomic nervous system and neuroendocrine changes in patients with idiopathic trigeminal neuralgia. Cephalalgia 1996;16:476–80.