[Left ventricular apical ballooning]

A 40-year-old woman and a 50-year-old man were admitted with acute chest pain indicative of an acute coronary syndrome.

In addition to ECG changes suggestive of acute ischemia and a minor increase in the serum concentration of troponin-I both patients had a severely reduced left ventricular function with extensive apical akinesis on echocardiography (LV- ejection fraction 20, respectively 40%). Stenotic coronary artery disease was excluded by coronary angiography, however left ventriculography showed a "ballooned" apex resembling an aneurysm.

Both patients were observed and treated symptomatically in the intensive care unit. Within four weeks the LV-function had completely recovered in both patients. Both patients had an atypical acute coronary syndrome as indicated by electrocardiographic signs of ischemia and serological markers. After perusal of the relevant literature the diagnosis of "apical ballooning" based on the finding of a "ballooned" akinesis of the left ventricular apex in the absence of coronary artery stenosis or a reasonable alternative cause of myocardial ischemia was made. The aneurysm-like left ventricular dysfunction is fully reversible without specific treatment.

Left apical ballooning is a rare, but increasingly recognized diagnosis in patients presenting with the clinical picture of cardiac ischemia in the absence of coronary artery disease. The pathogenesis of the LV-dysfunction, which is reversible, is not known and the prognosis is good in patients who survive the initial period of severe ventricular dysfunction.