Apical ballooning syndrome

Takotsubo-like cardiomyopathy (TC) is an enigmatic cardiomyopathy,characterised by a reversible left ventricular (LV) dysfunction triggered frequently by physical or emotional stress, mimicking an acute coronary syndrome (ACS)

• characterised by transient wall-motion abnormalities involving apical and/or mid-portions or basal segments of the left ventricle in the absence of significant obstructive coronary disease or, conversely, in the presence of stenosis not related to the myocardial-involved region
  
  
• affected patients are generally postmenopausal women, whose symptoms and ECG changes mimic an acute myocardial infarction (AMI)
  • however, the release of the myocardial enzyme is limited if compared with the extent of LV dysfunction
  • the ECG does not reproduce the typical evolution of an AMI because ST elevation or ST depression, prominent negative T waves with long QT interval, and Q waves disappear in the follow-up
    
    
• the lack of history of cardiac disease, and the reversibility of ventricular dysfunction make this syndrome very difficult to explain from a pathophysiological point of view. Mortality and complication are extremely low if compared with either AMI-related in-hospital or out-of-hospital 1-year mortality
  
  
• reports suggest that TC accounts for 1.5-2.2% of patients presenting with symptoms that initially appeared to be an ACS
  
  
• has been estimated that as many as 6% of women presenting with an apparent ACS may actually have TC
  
  
• the aetiology has yet to be defined
  
  
• in the UK estimated that 2000-3000 per annum cases of TC

Reference:

• 1) Tsuchihashi K, Ueshima K, Uchida T, et al. For the angina pectoris-myocardial infarction investigations in Japan. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 2001;38:11-18.
• 2) Bybee KA, Prasad A. Stress-related cardiomyopathy syndrome. Circulation 2008;118:397-409
• 3) Cacciotti L et al. Observational study on Takotsubo-like cardiomyopathy: clinical features, diagnosis, prognosis and follow-up.BMJ Open. 2012 Oct 11;2(5).