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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@fhalcorcon.es or problesve@yahoo.es.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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 . . . [Full Text of this Article]

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