Stress-induced cardiomyopathy: not always apical ballooning

Apical ballooning (takotsubo syndrome) mimics acute myocardial infarction with transient apical dyskinesia and normal coronary arteries. It is often precipitated by emotional or physical stress. The prevalence of this syndrome has been increasing, probably because it is now more frequently recognized. Multiple theoretical hypotheses have been developed to explain its genesis, but the mechanism remains unclear. Rarely, cases of apical sparing and other wall motion involvement have been cited. We collected data on 12 patients who had acute myocardial infarction and normal coronary arteries with abnormal wall motion that had completely healed on repeat studies. Five patients had typical apical ballooning, and the other 7 had wall motion abnormalities in other segments. We determined that stress-induced cardiomyopathy can involve any wall of the myocardium and is not always apical ballooning.