Article Text

Effect of coronary angioplasty on “stunned” myocardium
  1. K M English,
  2. A Al-Mohammad,
  3. G D Oakley
  1. kateenglish10{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

A 64 year old ex-smoker with a past history of hypertension presented to the chest pain fast track clinic with a one month history of increasing breathlessness on exertion. He underwent treadmill exercise testing, and managed only 59 seconds of the Bruce protocol before developing breathlessness, ST segment elevation in leads II, III, avF, and then non-sustained ventricular tachycardia. In view of the severity of his symptoms and the changes on the exercise ECG, in-patient cardiac catheterisation was performed. This showed a 99% stenosis of the dominant right coronary artery (left hand panel). Left ventricular angiogram demonstrated akinesia of the inferoapical region (video sequence 1). The right coronary artery lesion underwent angioplasty and a 3.5 × 13 mm Coroflex stent was deployed with an excellent final result (right hand panel). Immediately following stent insertion, a further left ventricular angiogram was performed, demonstrating complete resolution of the inferoapical akinesia (video sequence 2). Following angioplasty the patient's symptom of exertional breathlessness has resolved.

Embedded Image

Embedded Image

These images show that critical ischaemia can lead to significant, but completely and immediately reversible, stunning of the myocardium. This is likely to be the pathological basis for the “anginal equivalent” of breathlessness, rather than chest pain, on exertion

Supplementary materials

    Effect of coronary angioplasty on "stunned"myocardium
    KM English, A Al-Mohammad, GD Oakley

    Video sequence 1
    Left ventricular angiogram demonstrating akinesia of the inferoapical region

    [View Video]
    File size: 4.21MB

    Video sequence 2
    Left ventricular angiogram demonstrating complete resolution of the inferoapical akinesia

    [View Video]
    File size: 4.45MB

    NOTE: Depending on your browser, you may need to click on the black screen to start each video sequence.
    If you have difficulties please send us a message via our feedback feature