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Updated: Aug 9, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
[Left ventricular apical ballooning]
M Kotzerke1, M Keim, Ch Haller
1I. Medizinische Klinik, Hegau-Bodensee-Kliniken, Singen. michael.kotzerke@hegau-klinikum.de
Insights
Left apical ballooning, a rare cause of cardiac ischemia without coronary artery disease, presents as a reversible left ventricular dysfunction. This condition, characterized by a "ballooned" apex, shows a good prognosis after initial recovery.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute coronary syndrome (ACS) is a common presentation of cardiac ischemia.
- Coronary artery disease (CAD) is the primary cause of ACS.
Observation:
- Two patients presented with symptoms of ACS, ECG changes, and elevated troponin-I.
- Echocardiography revealed severely reduced left ventricular function with apical akinesis and a "ballooned" apex.
- Coronary angiography excluded significant coronary artery stenosis.
Findings:
- A diagnosis of "apical ballooning" was made, characterized by reversible left ventricular dysfunction in the absence of CAD.
- Left ventricular function completely recovered within four weeks in both patients without specific treatment.
Implications:
- Apical ballooning is an increasingly recognized diagnosis mimicking ACS.
- The pathogenesis remains unknown, but the prognosis is favorable for survivors of the acute phase.
- This condition highlights the importance of considering non-CAD causes of myocardial ischemia.
History:
A 40-year-old woman and a 50-year-old man were admitted with acute chest pain indicative of an acute coronary syndrome.
Investigations:
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.
Diagnosis, Treatment And Course:
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.
Conclusion:
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.
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