Transient left ventricular apical ballooning--characterization of an increasingly common new diagnostic entity....

Transient left ventricular apical ballooning syndrome (ABS) is characterized by chest pain, electrocardiographic alterations mimicking acute myocardial infarction (MI), transient left ventricular apical dyskinesis and normal coronary angiogram. It usually has a favorable prognosis. We present the case of a 71-year-old female patient, with a history of respiratory infection, who was admitted to the emergency department with chest discomfort, electrocardiographic alterations suggesting anterolateral MI, and shock. The admission echocardiogram revealed apical dyskinesis and dilatation, basal hypercontractility and a left intraventricular gradient of 75.27 mmHg. Elevation of cardiac biomarkers was disproportionately low. Coronary angiography was normal and the echocardiographic abnormalities disappeared after the tenth day of hospitalization. We describe the diagnostic criteria and characteristics of ABS. It is more prevalent in post-menopausal women and has a recognized association with stress. Its incidence will probably rise with increasing awareness of this entity, aging populations, and wider access to echocardiography and cardiac catheterization.