Apical ballooning cardiomyopathy (Takotsubo or ampulla cardiomyopathy) is a well-known transient and localized left ventricular (LV) dysfunction characterized by apical severe hypokinesis, typical electrocardiogram (ECG) changes of negative T, and a lack of organic lesions of the coronary arteries which could cause myocardial ischemia leading to segmental asynergy. Here we report on two cases of transient cardiomyopathy showing atypically localized asynergy, which is different from Takotsubo cardiomyopathy. Case 1 was diagnosed as atypical Takotsubo cardiomyopathy, and the current findings suggest case 2 was viral myocarditis. These cases suggest that there exist variant patterns of transient cardiomyopathy, and non-invasive and serial clinical evaluations are important for differential diagnosis in acute and atypical cardiomyopathy.
Cardiomyopathy ; Acute ; Cases ; Localized ; Atypical

BACKGROUND/AIMS: To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography(TM) technology (ZST; Fujifilm Corp.). METHODS: Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. RESULTS: In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49+/-0.50, 3.65+/-0.48, respectively. After AASS, A and B scored 4.36+/-0.48 and 4.40+/-0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. CONCLUSIONS: EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited.
Endoscopes ; Endosonography ; Humans ; Judgment ; Mucins ; Pancreatic Diseases