Apical ballooning of the left ventricle: first series in white patients

Abstract

Background: A cardiac syndrome of "apical ballooning" was recently described, consisting of an acute onset of transient extensive akinesia of the apical and mid portions of the left ventricle, without significant stenosis on the coronary angiogram, accompanied by chest symptoms, ECG changes, and a limited release of cardiac markers disproportionate to the extent of akinesia. Until now, this syndrome has been reported only in Japanese patients. Objective: To describe 13 white patients who presented with this syndrome over the previous four years.Results: All but one of the patients were women with a mean age of 62 years. Eight of them presented with chest pain, of whom six had cardiogenic shock. In nine patients a triggering factor was identified: emotional stress in three, trauma in one, pneumonia in one, asthma crisis in one, exercise in two, and cerebrovascular accident in one. In all patients left ventriculography showed very extensive apical akinesia ("apical ballooning") in the absence of a significant coronary artery stenosis, not corresponding with the perfusion territory of a single epicardial coronary artery. Mean maximal creatine kinase MB and troponin rise were 27.4 µg/l (range 5.2-115.7 µg/l, median 16.6 µg/l) and 18.7 µg/l (range 2.0-97.6 µg/l, median 14.5 µg/l), respectively. Six patients were treated with intra-aortic balloon counterpulsation. One patient died of multiple organ failure. On necropsy, no myocardial infarction was found. In the 12 survivors, left ventricular systolic function recovered completely within three weeks. Conclusions: This is the first series of "apical ballooning" to be reported in white patients. Despite dramatic initial presentation, left ventricle function recovered completely within three weeks in the survivors.

Left ventricular apical ballooning: Not an uncommon variant of acute myocardial infarction in women

“…Data on recurrence of this syndrome are scarce. 5 One of our patients (No. 1) was diagnosed 10 years previously with an anterior MI with normal coronary arteries.…”

“…[4][5][6] Previous reports of dynamic LV outflow tract obstruction in the setting of acute anterior MI 7, 8 may be also related to this syndrome.…”

Takotsubo Syndrome in African‐American women with atypical presentations: a single‐center experience

“…The etiology of this novel clinical syndrome has been linked to a high sympathetic and catecholamine state. To date, the disease has been described in Japanese, 4 Caucasian European, 5 and Caucasian American 6 patients. The objective of this report is to describe unique clinical characteristics of this syndrome observed in African-American (AA) patients presenting to our center.…”

Cardiomiopatia de Takotsubo: uma causa rara de choque cardiogênico simulando infarto agudo do miocárdio

“…Many cases have been described in Japan, United States and Europe 8 . In Brazil, there are few reports 9 . The submission with cardiogenic shock is particularly less frequent, which only occurs in 4% of the cases 6,8 .…”

“…Upon the submission with supraunlevelling of segment ST, differentiating such situation from acute myocardial infarction is practically impossible without the findings of coronary angiography and many of those patients have thrombolytic inadvertently 9 .…”