A lady with a broken heart: Apical ballooning syndrome

Severe chest pain afteran emotional argumentresulted in the admissionof a healthy 72-year-oldwoman. She was haemodynamicallycompromised, with anelectrocardiogram (ECG) demonstratinganterior ST-depression and T-wave inversions(Fig. 1). Her 6-hour troponin T levelwas 132 ng/L. Cardiac catheterisationrevealed unobstructed coronary arteriesand a reduced left ventricular ejectionfraction (LVEF) of <35%, with basalhyperkinesia and apical segment ballooning(Figs 2 - 5). She was discharged home after3 days of supportive therapy. At 3 monthsshe was asymptomatic, with an equilibriumradionuclide angiography scan revealing anormal heart with an LVEF of 73%.