title: Two cases of apical ballooning syndrome masking apical hypertrophic cardiomyopathy.
abstract: Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy is seen in apical-variant hypertrophic cardiomyopathy. We report the cases of 2 patients who presented with takotsubo cardiomyopathy and were subsequently found to have apical-variant hypertrophic cardiomyopathy, after the apical ballooning from the takotsubo cardiomyopathy had resolved. The first patient, a 43-year-old woman with a history of alcohol abuse, presented with shortness of breath, electrocardiographic and echocardiographic features consistent with takotsubo cardiomyopathy, and no significant coronary artery disease. An echocardiogram 2 weeks later revealed a normal left ventricular ejection fraction and newly apparent apical hypertrophy. The 2nd patient, a 70-year-old woman with pancreatitis, presented with chest pain, apical akinesis, and a left ventricular ejection fraction of 0.39, consistent with takotsubo cardiomyopathy. One month later, her left ventricular ejection fraction was normal; however, hypertrophy of the left ventricular apex was newly noted. To our knowledge, these are the first reported cases in which apical-variant hypertrophic cardiomyopathy was masked by apical ballooning from stress-induced cardiomyopathy.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259.
authors.forename: Ranjini Raina
authors.initials: RR
authors.lastname: Roy
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259.
authors.forename: Fayaz A
authors.initials: FA
authors.lastname: Hakim
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Hurst
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259.
authors.forename: David
authors.initials: D
authors.lastname: Simper
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Appleton
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D010195:Pancreatitis / Q000150:complications; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Cardiomyopathy, hypertrophic/complications/diagnosis; heart ventricles/physiopathology; takotsubo cardiomyopathy/diagnosis/physiopathology; time factors; ventricular dysfunction, left