[Transient Q wave in adrenergic myocarditis. Contribution of echocardiography apropos of a case]

Abstract

The authors report the occurrence of a transient Q wave in a case of adrenergic myocarditis consecutive to a hypersecretory phaeochromocytoma. There was no biochemical evidence of anatomical infarction. During a hyperadrenergic clinical attack, electrocardiography displayed a pattern of incipient anteroseptal infarction with a Q wave of necrosis, while echocardiography recorded a very low and paradoxical septal contraction together with marked abnormalities of mitral valve kinetics. Under medical treatment the Q wave totally regressed within a few hours, without rise in enzyme levels. The echocardiographic abnormalities gradually disappeared over a few days. After surgical excision of the phaeochromocytoma, both electrocardiography and echocardiography were perfectly normal. In such cases the Q wave is most probably due to a direct impact of catecholamines of the myocardium, with deep but reversible alterations of cellular metabolism. The echocardiographic abnormalities reflect an acute disorder of ventricular filling responsible for delay in mitral valve opening and disappearance of the E wave. The paradoxical septal kinetics are more difficult to explain; they seem to be related to adrenergic hyperactivity.