Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina.
BACKGROUND
Takotsubo or ampulla transient left ventricular apical ballooning (LVAB) cardiomyopathy has been described as a clinical syndrome characterized by the sudden onset of chest pain, cardiac failure, ischemic changes on electrocardiography, and apical severe myocardial dysfunction in the presence of "normal" coronary arteries on angiography. All features last from a few days to a few weeks.


RESULTS
On the basis of previous knowledge and in light of our recent experience with acetylcholine testing in this condition, the cases of four patients are described and preliminary but sound arguments are given to support the theory that LVAB is caused by severe, sustained spasm of many or all of the coronary vessels. In one of these patients, experimental reproduction of LVAB occurred in the catheterization laboratory during acetylcholine testing (as evidenced by echocardiographic monitoring), while in two other patients, the test provoked similar, extensive angiographic vasospasm and suggestive symptoms. In addition, the similarities and differences that exist between LVAB and Prinzmetal angina are discussed.


CONCLUSIONS
To evaluate the pathogenesis of LVAB, it is proposed that acetylcholine testing be routinely performed under specific, prospective, investigational protocols at specialized centers.
Angelini
Paolo
P
Baylor College of Medicine, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA. pangelinimd@houston.rr.com
D000369:Aged, 80 and over; D000788:Angina Pectoris, Variant / Q000175:diagnosis* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011875:Radionuclide Angiography / Q000379:methods; D015635:Radionuclide Ventriculography / Q000379:methods; D012008:Recurrence; D012075:Remission, Spontaneous; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology