Transient cardiac ballooning--the syndrome.
Transient cardiac ballooning is usually a reversible clinical entity. A patient typically presents with chest pain, electrocardiogram (ECG) abnormalities like ST-segment elevation (most commonly reported) or depression, and elevated cardiac enzymes, but has no or nonobstructive coronary artery disease. Left ventriculography reveals transient akinesis of the involved portion of the myocardial wall with compensatory hyperkinesis of the remaining myocardium, leading to ballooning of the noncontracting myocardial wall during systole. Acute regional myocardial dysfunction ensues, which normalizes on average within 1 to 6 weeks. The hypotheses for these pathophysiologic changes range from direct cardiac myocyte injury to postischemic myocardial stunning to neurotransmitter actions. The objective of this article is to present a succinct description of a small case series accompanied with various recently reported presentations and morphology by left ventriculogram and a detailed review of available data on underlying pathophysiology. In addition, a discussion on current diagnostic guidelines, treatment, prognosis, and potential future investigations is included.
Gupta
Raghav
R
Section of Cardiovascular Diseases, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. raghav-gupta@ouhsc.edu
Sech
Candice
C
Lazzara
Ralph
R
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000201:enzymology / Q000473:pathology; D017410:Practice Guidelines as Topic; D013315:Stress, Psychological / Q000150:complications; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D015854:Up-Regulation; D016277:Ventricular Function, Left
D015415:Biomarkers; D002317:Cardiovascular Agents