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(Circulation. 2006;113:e686-e688.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Atypical Transient Left Ventricular Ballooning Without Involvement of Apical Segment

Pablo Robles, MD; Manuel Alonso, MD; Ana Isabel Huelmos, MD; Jose Julio Jiménez, MD; Lorenzo López Bescós, MD

From the Department of Cardiology, Fundación Hospital Alcorcón, Alcorcón (Madrid), Spain.

Correspondence to Pablo Robles, MD, Unidad de Cardiología, Avda Budapest No. 1 28922, Alcorcón 28922 (Madrid), Spain. E-mail probles{at}fhalcorcon.es or problesve@yahoo.es.

Recently, the Mayo Clinic proposed criteria for the clinical diagnosis of the syndrome of left ventricular transient apical ballooning. This syndrome consists of the acute onset of transient, extensive akinesia of the apical and middle portions of the left ventricle without significant stenosis evident on the coronary angiogram, accompanied by chest symptoms, ECG changes, and limited release of cardiac markers disproportionate to the extent of akinesia. We report a case of a 65-year-old woman with chest pain, new ECG abnormalities (Figure 1), elevations of cardiac biomarker levels, and the absence of obstructive epicardial coronary disease with transient wall-motion abnormalities involving the middle portions of the left ventricle but not involving the left ventricular apex. In this case, the apex and basal segments were hypercontracting (Figure 2 and Movie I in the online Data Supplement). Two months later, a transthoracic echocardiographic examination showed recovery of midventricular wall motion (Movie II through Movie V).

View larger version (227K): [in this window] [in a new window]   Figure 1. Top, ECG on admission shows a discrete ST-segment elevation in leads V2 through V4. Bottom, The ECG 12 hours later shows a T-wave inversion in leads V2 through V6, I, aVL, and III, with a prolonged QT interval.

View larger version (75K): [in this window] [in a new window]   Figure 2. End-diastolic (left) and end-systolic (right) ventriculograms of the patient, showing akinesia of the middle segments of the left ventricle and hypercontraction of basal and apical segments.

Tawarahara et al¹ have reported a variant of reversible, severe left ventricular wall-motion abnormalities involving the basal segment with hypercontraction of the apex, but no other occurrence was found in the literature of an atypical presentation of this syndrome. This case shows that this syndrome does not correspond to any well-known pathophysiological mechanism and therefore, the name of this syndrome may need to be reevaluated in the future.

	Disclosures

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None.

	Footnotes

 
The online-only Data Supplement, which includes 5 movies, can be found at http://circ.ahajournals.org/cgi/content/full/113/14/e686/DC1.

	Reference

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1. Tawarahara K, Matoh F, Odagiri K, et al. Nuclear cardiac imaging in "Tsubo-like (Pod-like)" transient left ventricular dysfunction. Circ J. 2001; 65 (suppl 1-A): 420.
   

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This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Robles, P. Articles by Bescós, L. L. Search for Related Content PubMed PubMed Citation Articles by Robles, P. Articles by Bescós, L. L. Related Collections Acute coronary syndromes Other diagnostic testing Related Article