title: Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan.
abstract: OBJECTIVE
  To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.
  
  
  BACKGROUND
  Only several case presentations have been reported with regard to this syndrome.
  
  
  METHODS
  We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.
  
  
  RESULTS
  Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly.
  
  
  CONCLUSIONS
  A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.
authors.affiliation: Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan. tsuchiha@sapmed.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: K
authors.initials: K
authors.lastname: Ueshima
authors.forename: T
authors.initials: T
authors.lastname: Uchida
authors.forename: N
authors.initials: N
authors.lastname: Oh-mura
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: M
authors.initials: M
authors.lastname: Owa
authors.forename: M
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: S
authors.initials: S
authors.lastname: Miyazaki
authors.forename: K
authors.initials: K
authors.lastname: Haze
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Honda
authors.forename: M
authors.initials: M
authors.lastname: Hase
authors.forename: R
authors.initials: R
authors.lastname: Kai
authors.forename: I
authors.initials: I
authors.lastname: Morii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000175:diagnosis*; D002648:Child; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D012189:Retrospective Studies; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*; D017725:Ventricular Pressure