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(Circulation. 2003;108:2014.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Transient Left Ventricular Apical Ballooning

C. Witzke, MD; H.C. Lowe, MD; H. Waldman, MD; I.F. Palacios, MD

From the Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Dr I.F. Palacios, Director of Cardiac Catheterization Laboratories, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Bullfinch 105, Boston, MA 02144-2696. E-mail ipalacios{at}partners.org

A 69-year-old woman presented with acute onset of chest pain and diffuse ST-segment elevation suggesting ischemia (Figure 1). The creatine phosphokinase–MB was elevated, and in view of ongoing chest discomfort, she was referred for urgent cardiac catheterization.

View larger version (90K): [in this window] [in a new window]   Figure 1. Twelve-lead ECG showing normal sinus rhythm and extensive anterior wall ST-segmental abnormalities.

Coronary angiography revealed normal coronary arteries. Ventriculography demonstrated a markedly abnormal left ventricle, with apical ballooning in systole (Figure 2A and 2B). Overall left ventricular function was depressed, with an ejection fraction of 33% and severe mitral regurgitation (Figure 2A and 2B). A midcavity left ventricle gradient of 25 mm Hg was also noted. With supportive therapy, spontaneous clinical recovery occurred within 1 week and left ventricular function returned to normal on follow-up echocardiography at 40 days.

View larger version (69K): [in this window] [in a new window]   Figure 2. End-diastolic (A) and end-systolic (B) frame of left ventriculography showing anterolateral, anteroapical, and apical inferior wall dyskinesis with hypercontractile base (left ventricular apical ballooning).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Witzke, C. Articles by Palacios, I.F. Search for Related Content PubMed PubMed Citation Articles by Witzke, C. Articles by Palacios, I.F. Related Collections Acute coronary syndromes Acute myocardial infarction Myocardial cardiomyopathy disease Coronary imaging: angiography/ultrasound/Doppler/CC