Apical ballooning syndrome--a review of five cases

Takotsubo syndrome (apical ballooning syndrome) was described for the first time in Japan, at the beginning of the 1990s. It is characterized by the acute onset of extensive but transient akinesia of the apical and mid portions of the left ventricle, in the absence of significant coronary disease.

We describe five patients who were admitted to our hospital with this new syndrome between June 2004 and December 2005. These patients represented 0.8% of a total of 613 patients admitted for acute myocardial infarction in that period.

All the patients were female, with a mean age of 60.2+/-10.3 years. Chest pain was the most frequent clinical presentation (n=5). A possible triggering factor, intense emotional stress, was identified in two patients. At admission, the electrocardiogram showed ST elevation in two patients and Q waves in the precordial leads in one. All cases had negative T waves in the precordial leads at some point. All patients had increased troponin levels but only two had elevated cardiac enzymes. The echocardiogram revealed extensive akinesia of the apical and mid portions of the left ventricle, and a thrombus was observed in one patient. Coronary angiography showed no significant lesions. Currently, all five patients are virtually asymptomatic, with regression of left ventricular wall-motion abnormalities on echocardiography.

This is the first series of apical ballooning syndrome described in Portugal. Although rare, it should be considered in the differential diagnosis of acute myocardial infarction. Despite its transient nature, in the acute phase it can be a serious condition. More research is needed to better characterize this new entity.