Reversible left ventricular dysfunction (takotsubo cardiomyopathy) with deep negative T waves due to possible cardiac sympathetic denervation.

A case of characteristic left ventricular contraction disorder representing takotsubo cardiomyopathy after exercise is reported. A 58-year-old Japanese woman with no history of cardiac disease was admitted for chest oppression after exercise. A diagnosis of myocardial infarction was suspected because of her symptom, and the electrocardiographic and echocardiographic findings. Coronary angiography revealed normal arteries, while left ventriculography demonstrated asynergy with apical akinesis and basal hyperkinesis. Deep negative T waves were observed on the electrocardiogram on the second hospital day and sustained for over a month. Repeated measurements of heart rate viability and 123I-metaiodobenzylguanidine scintigraphy showed transient dysfunction of the cardiac autonomic nervous system. From these findings, it was concluded that cardiac autonomic denervation plays a pivotal role in the etiology of takotsubo cardiomyopathy.