Abstract
Patients with Guillain‐Barré syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with Guillain‐Barré syndrome who developed ST‐segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. Cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow.
Keywords: intracoronary Doppler, coronary flow velocity reserve, Guillain‐Barré syndrome
Full Text
The Full Text of this article is available as a PDF (965.7 KB).
References
- 1. Minahan RE, Bhardwaj A, Traill TA, Hanley DF: Stimulus‐evoked sinus arrest in severe Guillain‐Barré syndrome: A case report. Neurology 1996; 47: 1239–1242 [DOI] [PubMed] [Google Scholar]
- 2. Greenland P, Griggs RC: Arrhythmic complications in the Guillain‐Barré syndrome. Arch Intern Med 1980; 140: 1053–1055 [PubMed] [Google Scholar]
- 3. Feiden W, Gerhard L, Borchard F: Neuritis cordis due to the acute polyneuritis of the Guillain‐Barré syndrome. Virchows Arch A Pathol Anat Histopathol 1988; 413: 573–580 [DOI] [PubMed] [Google Scholar]
- 4. Hodson AK, Hurwitz BJ, Albrecht R: Dysautonomia in Guillain‐Barré syndrome with dorsal root ganglioneuropathy, wallerian degeneration, and fatal myocarditis. Ann Neurol 1984; 15: 88–95 [DOI] [PubMed] [Google Scholar]
- 5. Lichtenfeld P: Autonomic dysfunction in the Guillain‐Barré syndrome. Am J Med 1971; 50: 772–780 [DOI] [PubMed] [Google Scholar]
- 6. McDougall AJ, McLeod JG: Autonomic neuropathy, II: Specified peripheral neuropathies. J Neurol Sci 1996; 138: 1–13 [DOI] [PubMed] [Google Scholar]
- 7. Carlier SG, Di Mario C, Kern MJ, Serruys PW: Intracoronary Doppler and pressure monitoring In Textbook of Interventional Cardiology (Ed. Topol EJ.), 3rd edition, p. 748–781. Philadelphia: W.B. Saunders Co., 1999. [Google Scholar]
- 8. Durocher A, Servis B, Caridroix M, Chopin C, Wattel F: Autonomic dysfunction in the Guillain‐Barré syndrome. Hemodynamic and neurobiochemical studies. Intens Care Med 1980; 6: 3–6 [DOI] [PubMed] [Google Scholar]
- 9. Feigl EO: The paradox of adrenergic coronary vasoconstriction. Circulation 1987; 76: 737–745 [DOI] [PubMed] [Google Scholar]
- 10. Baumgart D, Ehring T, Kowallik P, Guth BD, Krajcar M, Heusch G: Impact of α‐adrenergic coronary vasoconstriction on the transmural myocardial blood flow distribution during humoral and neuronal adrenergic activation. Circ Res 1993; 73: 869–886. [DOI] [PubMed] [Google Scholar]
- 11. Baumgart D, Heusch G: Neuronal control of coronary blood flow. Basic Res Cardiol 1995; 90: 142–159 [DOI] [PubMed] [Google Scholar]