Transient impairment of myocardial perfusion in a patient with apical ballooning syndrome.
We describe a case of a 76-year-old woman who presented with chest pain after a violent argument. On admission the electrocardiogram showed 1-mm ST segment elevation in II, III, aVF, V3-V6 leads; the subsequent electrocardiogram showed T-wave inversion in the same leads. Peak troponin I level was 7.3 ng/dl (normal <0.4 ng/dl). Emergency angiography demonstrated the so-called "apical ballooning", in the absence of any obstructive coronary artery disease. A myocardial contrast echocardiogram performed 5 days later showed a large perfusion defect in the akinetic apical region of the left ventricle; at 1-month follow-up myocardial perfusion and left ventricular wall motion became completely normal. In patients with apical ballooning syndrome a catecholamine-mediated endothelial injury might be responsible of a microvascular coronary dysfunction which causes myocardial ischemia and subsequent myocardial stunning.
Azzarelli
Salvatore
S
Giordano
Guido
G
Galassi
Alfredo R
AR
Amico
Francesco
F
Giacoppo
Michele
M
Argentino
Vincenzo
V
Fiscella
Antonio
A
D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications*