Atypical Transient Left Ventricular Ballooning Without Involvement of Apical Segment
Recently, the Mayo Clinic proposed criteria for the clinical diagnosis of the syndrome of left ventricular transient apical ballooning. This syndrome consists of the acute onset of transient, extensive akinesia of the apical and middle portions of the left ventricle without significant stenosis evident on the coronary angiogram, accompanied by chest symptoms, ECG changes, and limited release of cardiac markers disproportionate to the extent of akinesia. We report a case of a 65-year-old woman with chest pain, new ECG abnormalities (Figure 1), elevations of cardiac biomarker levels, and the absence of obstructive epicardial coronary disease with transient wall-motion abnormalities involving the middle portions of the left ventricle but not involving the left ventricular apex. In this case, the apex and basal segments were hypercontracting (Figure 2 and Movie I in the online Data Supplement). Two months later, a transthoracic echocardiographic examination showed recovery of midventricular wall motion (Movie II through Movie V).
Tawarahara et al1 have reported a variant of reversible, severe left ventricular wall-motion abnormalities involving the basal segment with hypercontraction of the apex, but no other occurrence was found in the literature of an atypical presentation of this syndrome. This case shows that this syndrome does not correspond to any well-known pathophysiological mechanism and therefore, the name of this syndrome may need to be reevaluated in the future.
The online-only Data Supplement, which includes 5 movies, can be found at http://circ.ahajournals.org/cgi/content/full/113/14/e686/DC1.