title: Clinical features of transient left ventricular apical ballooning.
abstract: This report describes the clinical characteristics of 8 consecutive patients with transient left ventricular apical ballooning identified among 389 patients (2%) admitted to a tertiary referral hospital with suspected acute coronary syndromes over a 1-year period. Among these patients, 2 cases appeared to be caused by acute myocarditis and 1 case by head trauma with intracranial bleeding. In the remaining 5 cases, no apparent cause was found. All patients but 1 were postmenopausal women (mean age 60 +/- 13.5 years). Preceding strong emotional or physical stress was present in 6 patients. The presenting symptom in 7 patients was chest pain. Four patients had significant ST-segment elevation, and the remaining 4 had T-wave inversions on their admission electrocardiograms. Mean peak troponin I was moderately elevated (3.7 +/- 4.5 ng/dl). The mean echocardiographic left ventricular ejection fraction was 40 +/- 10% on admission and increased significantly to 63 +/- 4% at 1-month follow-up (p <0.0001). All patients but 1 had abnormal corrected Thrombolysis In Myocardial Infarction frame counts (>27 frames) in >or=1 major epicardial coronary artery. All patients were alive and without major adverse cardiac events at 6-month follow-up. In conclusion, transient left ventricular apical ballooning should be considered in the differential diagnosis of patients presenting with suspected acute coronary syndromes, because it may account for approximately 2% of hospital admissions.
authors.affiliation: Cardiovascular Catheterization Unit, Cardiovascular Department, Cannizzaro Hospital, University of Catania, Catania, Italy. azzarelli.s@tiscali.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Azzarelli
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
authors.forename: Francesco
authors.initials: F
authors.lastname: Amico
authors.forename: Michele
authors.initials: M
authors.lastname: Giacoppo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Argentino
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiscella
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D020198:Intracranial Hemorrhage, Traumatic / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013318:Stroke Volume; D013577:Syndrome; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D007075:Immunoglobulin M; D019210:Troponin I