title: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review.
abstract: OBJECTIVE
  To clarify the major features of the apical ballooning syndrome, we performed a systematic review of the existing literature.
  
  
  RESULTS
  Review of all relevant case series using the MEDLINE and EMBASE databases resulted in the identification of 14 studies. These studies suggest that the apical ballooning syndrome accounts for approximately 2.0% of ST-segment elevation infarcts, with most cases described in post-menopausal women. The most common clinical presentations are chest pain and dyspnoea, reported in 67.8 and 17.8% of the patients, respectively. Cardiogenic shock (4.2% of the patients) and ventricular fibrillation (1.5%) were not infrequent. ST-segment elevation was reported in 81.6% of the patients, T wave abnormalities in 64.3%, and Q waves in 31.8%. Cardiac biomarkers were usually mildly elevated, as reported in 86.2% of the patients. Typically, patients had left ventricular (LV) dysfunction on admission, with mean ejection fraction ranging from 20 to 49%. However, over a period of days to weeks, all patients experienced dramatic improvement in LV function. The onset of symptoms was often preceded by emotional (26.8%) or physical stress (37.8%). Norepinephrine concentration was elevated in 74.3% of the patients. Prognosis was generally excellent, with full recovery in most patients. In-hospital mortality was 1.1%. Only 3.5% of the patients experienced a recurrence.
  
  
  CONCLUSIONS
  Clinicians should consider this syndrome in the differential diagnosis of patients presenting with chest pain, especially in post-menopausal women with a recent history of emotional or physical stress.
authors.affiliation: Department of Clinical Medicine, University of Insubria, Varese, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Gianni
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Grandi
authors.forename: Glen
authors.initials: G
authors.lastname: Sumner
authors.forename: Rajesh
authors.initials: R
authors.lastname: Hiralal
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011379:Prognosis; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: D015415:Biomarkers