[Transient left ventricular apical ballooning or the tako-tsubo syndrome]

Recently, Japanese authors have described a new clinical entity associating apical akidyskinesia and basal hyperkinesias without significant coronary artery disease under the name of the tako-tsubo syndrome. This syndrome is usually observed in elderly women and the clinical presentation is usually that of an acute coronary syndrome. The authors report 10 cases of patients investigated between June 2003 and August 2004. All patients were women with an average age of 66 +/- 15 years. Seven patients had chest pain on admission with, in three cases, signs of cardiac failure. In 8 patients, a causal factor was identified: emotional stress in 7 cases and anaphylactic shock in one case. All patients underwent coronary angiography and ventriculography which showed typical changes in left ventricular contractility without significant coronary disease. The peak CPK and troponin values were 222 +/- 115 UI/l and 3.32 +/- 1.50 microg/l, respectively. One patient died in cardiogenic shock. In the other cases, normalisation of wall motion was observed in the month following the onset of symptoms. One patient developed 3rd degree atrioventricular block and required implantation of a pacemaker. This clinical entity must be taken into consideration in elderly women with acute coronary syndromes.