title: Stress cardiomyopathy: case series and the review of literature.
abstract: BACKGROUND
  Apical ballooning syndrome (ABS) or stress cardiomyopathy is increasingly recognized as a cause of acute coronary syndrome with unobstructed coronaries, but remains underdiagnosed.
  
  
  OBJECTIVE
  Retrospective review of the angiographic database (between January 2006 and December 2010) to obtain incidence and clinical presentation of ABS at our center. ABS was defined according to the modified Mayo Clinic criteria.
  
  
  METHODS
  Normal or unobstructed coronaries on angiography were observed in 1780 (25.4%) of a total of 6983 patients who underwent urgent or emergency coronary angiography. Twelve patients (0.17%) fulfilled the modified Mayo Clinic criteria for ABS. Eleven patients (92%) were aged ≥ 50 years (median 68 years, range 27-86 years), and 10 were female (83%). Four patients (31%) presented with ST-elevation myocardial infarction, and 1 patient presented with cardiogenic shock and acute coronary syndrome. Emotional stress was the precipitant in 4 patients (33%). Unusual precipitants like cold-water immersion and intravenous chemotherapy were observed. All 12 patients had the typical appearance of ABS on left ventriculogram (75%) or echocardiography (25%). Follow-up imaging with either echocardiography or magnetic resonance imaging (done in all 12 patients) up to 16 weeks after discharge showed that left ventricular function had normalized.
  
  
  CONCLUSIONS
  The incidence and clinical features of ABS in our tertiary center are similar to those reported in other settings. Unusual precipitants were observed, but left ventriculograms were performed less frequently and could be contributory to the under-diagnosis of ABS.
authors.affiliation: Morriston Hospital Cardiac Centre, Swansea, Wales, United Kingdom.
authors.forename: Vinoda
authors.initials: V
authors.lastname: Sharma
authors.forename: Manivannan
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Daniel Mark
authors.initials: DM
authors.lastname: Sheehan
authors.forename: Adrian
authors.initials: A
authors.lastname: Ionescu
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy; D004452:Echocardiography; D005260:Female; D006801:Humans; D007101:Immersion / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: ABS; ACS; Takotsubo cardiomyopathy; stress cardiomyopathy