Dynamic Left Ventricular Outflow Tract Obstruction with Cardiogenic Shock in Apical Ballooning Syndrome

Apical ballooning syndrome, also called Takotsubo cardiomyopathy, is characterized by transient systolic dysfunction of mid to apical segments and hyperkinesis of basal segments of the left ventricle that mimic acute myocardial infarction without significant coronary artery stenosis. We reported a 51-year-old man with chest distress, hypotension and abnormal electrocardiogram. Echocardiography revealed extensive akinesia of the mid to apical portions of the left ventricle, hyperkinesia of basal segments of the left ventricle, increasing left ventricle outflow tract velocity and severe mitral regurgitation. Cardiac catheterization showed a normal coronary angiography and an obvious pressure gradient between the left ventricle and aorta. After we discontinued administration of nitrates, provided mild hydration and initiated intravenous dopamine infusion, the patient's hypotension, left ventricular to aortic pressure gradient, and severe mitral regurgitation resolved the next day. Thereafter, apical ballooning syndrome with dynamic left ventricular outflow tract obstruction, severe mitral regurgitation and cardiogenic shock was diagnosed.

Apical ballooning syndrome; Cardiogenic shock; Left ventricular outflow tract obstruction; Mitral regurgitation.