"Familial" apical ballooning syndrome (Takotsubo cardiomyopathy)

We present a case of a 44 year-old woman who was diagnosed with apical ballooning syndrome (ABS). She reported that her family history consisted of her mother suffering a myocardial infarction at the age of 49 years. The mother had been told that she had normal coronary arteries and was treated for coronary artery spasm. We reviewed the medical records, coronary angiogram and left ventriculogram of the mother, and concluded that she too had suffered an episode of ABS which had been diagnosed as a myocardial infarction. Our observation of a familial clustering of ABS has two important implications. First, it suggests that there may be a genetic predisposition for the cardiomyopathy which may explain why only a minority of postmenopausal women appear to be susceptible. Second, it illustrates that despite the apparent recent emergence of the syndrome, it did occur in the past.