case_images: PMC4008090_01
case_images: Chest leads electrocardiogram showing ST-segment elevations in V2, V3, and V4.
case_images: CRIM.CARDIOLOGY2012-486427.001.jpg
case_images: PMC4008090_01_CRIM.CARDIOLOGY2012-486427.001.jpg
case_images: fig1
case_images: The initial ECG showed ST-elevation in the precordial leads from V2 to V4 (Figure 1).
case_images: Coronary angiogram minor disease in the left anterior descending artery but no other coronary artery disease.
case_images: CRIM.CARDIOLOGY2012-486427.002.jpg
case_images: PMC4008090_01_CRIM.CARDIOLOGY2012-486427.002.jpg
case_images: fig2
case_images: Coronary angiogram, however, showed some atherosclerotic coronary artery disease, but no significant stenosis (Figure 2).
case_images: LV angiogram in diastole (a) and systole (b) in right anterior oblique projection demonstrating wall-motion abnormality characteristic of stress cardiomyopathy. At end systole, LV chamber adopts distinctive "short neck with round flask" configuration in which distal (apical) portion is akinetic/hypokinetic, whereas in contrast, the remaining proximal (basal) segment is hypercontractile. Left panel, angiogram after 4 days.
case_images: CRIM.CARDIOLOGY2012-486427.003.jpg
case_images: PMC4008090_01_CRIM.CARDIOLOGY2012-486427.003.jpg
case_images: fig3
case_images: Left ventriculography demonstrated typical apical ballooning with a globally reduced ejection fraction estimated at 35% (Figure 3).
case_images: Pressure tracings show a sharp rise in LV outflow gradient that follows the pause associated with PVC. A dynamic obstruction leads to a concomitant fall in aortic pressure and a disproportionate (46 to 130 mmHg) increase in gradient. This phenomenon, known as the Brockenbrough-Braunwald-Morrow sign, is part of the classical description of hypertrophic obstructive cardiomyopathy. Ao: aorta; ECG: electrocardiogram; LV: left ventricle; PVC: premature ventricular complex.
case_images: CRIM.CARDIOLOGY2012-486427.004.jpg
case_images: PMC4008090_01_CRIM.CARDIOLOGY2012-486427.004.jpg
case_images: fig4
case_images: Pressure tracings showed no pressure gradient between the LV and the aorta (Figure 4).
case_images: Pressure tracings show a sharp rise in LV outflow gradient that follows the pause associated with PVC. A dynamic obstruction leads to a concomitant fall in aortic pressure and a disproportionate (46 to 130 mmHg) increase in gradient. This phenomenon, known as the Brockenbrough-Braunwald-Morrow sign, is part of the classical description of hypertrophic obstructive cardiomyopathy. Ao: aorta; ECG: electrocardiogram; LV: left ventricle; PVC: premature ventricular complex.
case_images: CRIM.CARDIOLOGY2012-486427.005.jpg
case_images: PMC4008090_01_CRIM.CARDIOLOGY2012-486427.005.jpg
case_images: fig5
case_images: On day four, a second invasive hemodynamic evaluation was performed, confirming a simultaneous pressure gradient between the LV and aorta of 45 mmHg at rest that increased to 70 mmHg after Valsalva maneuver (Figure 5).