Apical ballooning syndrome associated with isolated severe hyponatremia: case report and suggested pathophysiology

An 82-year-old woman who presented to her primary care physician for preoperative evaluation was incidentally found to have severe hyponatremia (sodium = 118 mmol/L). The patient was then admitted for workup and treatment of hyponatremia. On day 2 of the admission, the patient was found to have new T-wave inversions on a telemetry monitor. Further workup, including an electrocardiogram, cardiac markers, echocardiogram, and a cardiac catheterization were consistent with the diagnosis of apical ballooning syndrome (ABS). Mechanisms of how severe hyponatremia may lead to ABS are discussed as well as a possible approach to the management of severe hyponatremia in postmenopausal women.