title: Therapeutic challenges in combined apical ballooning syndrome and acute pulmonary decompensation.
abstract: Apical ballooning syndrome (ABS) is increasingly diagnosed in critical care settings. Widespread application of echocardiography and cardiac enzyme testing has increased its recognition. Our experience of 4 subjects illustrates the association of ABS with a wide spectrum of acute pulmonary disorders seen in critical care settings. All had ABS proven by normal coronary angiogram and subsequent normalization of left ventricular dysfunction. Bronchospasm due to chronic obstructive pulmonary disease exacerbation or cardiac failure warrants the use of beta agonists. ABS, on the other hand, being caused by excess sympathetic activity could potentially improve with beta blockade. Coexistence of ABS and pulmonary disease in critical-care settings presents unique therapeutic challenges and outcomes can be optimized by judicious use of available medical options.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
authors.forename: Chelif
authors.initials: C
authors.lastname: Junor
authors.forename: Kimberly
authors.initials: K
authors.lastname: Delcour
authors.forename: Anand
authors.initials: A
authors.lastname: Chockalingam
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001986:Bronchial Spasm / Q000188:drug therapy / Q000209:etiology; D017023:Coronary Angiography; D003422:Critical Care; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy
chemical_list: D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists