Apical Ballooning Syndrome: The Broken Heart Syndrome
Four case studies of apical ballooning syndrome are reported to demonstrate the typical presentation, specific cardiac imaging, and clinical outcomes. Most patients are women and present with symptoms of acute coronary syndrome precipitated by emotional distress or physical stressors. Electrocardiograms (ECGs) may vary from nonspecific ST-T changes to full-blown manifestations of ST segment elevation infarct. Cardiac markers demonstrate minimal or moderate elevations. Basal hypercontractility and apical ballooning are classical cardiac imaging and coronary arteries are usually normal. Patients are expected to have an uneventful hospital course and complete left ventricular function recovery, and most patients do not have any recurrences.
Apical ballooning syndrome (ABS) is a reversible, transient cardiomyopathy, present in about 2% of patients presenting with an acute coronary syndrome (ACS). ABS was first described in the Japanese population in the 1990s; this disease entity was named Tako-Tsubo cardiomyopathy because of the way the left ventricle appeared on ventriculogram. The hypokinetic mid-ventricle and apex with a rounded bottom and narrow neck in systole resemble the traditional Japanese octopus trap for which it was named. ABS is also referred to as "stress" or "ampulla" cardiomyopathy, and as "the broken heart syndrome."
This cardiomyopathy is unique in that it is often precipitated by emotional or physical stressors including natural disasters, the sudden death of a loved one, serious medical illness, and noncardiac surgery. There have also been reports of professional sporting events triggering ABS. Because most patients in early publications were Japanese, ABS was initially thought to be a geographically isolated phenomenon with Asian descents. This cardiomyopathy has recently been documented in European, Australian, and North American patients, and the lack of prior reports in the western world may have simply been due to the lack of awareness of the disease entity. ABS is an emerging and under-recognized cardiomyopathy mimicking ST elevation infarct, and a high index of clinical suspicion is needed to correctly identify this transient cardiomyopathy.
Abstract and Introduction
Abstract
Four case studies of apical ballooning syndrome are reported to demonstrate the typical presentation, specific cardiac imaging, and clinical outcomes. Most patients are women and present with symptoms of acute coronary syndrome precipitated by emotional distress or physical stressors. Electrocardiograms (ECGs) may vary from nonspecific ST-T changes to full-blown manifestations of ST segment elevation infarct. Cardiac markers demonstrate minimal or moderate elevations. Basal hypercontractility and apical ballooning are classical cardiac imaging and coronary arteries are usually normal. Patients are expected to have an uneventful hospital course and complete left ventricular function recovery, and most patients do not have any recurrences.
Introduction
Apical ballooning syndrome (ABS) is a reversible, transient cardiomyopathy, present in about 2% of patients presenting with an acute coronary syndrome (ACS). ABS was first described in the Japanese population in the 1990s; this disease entity was named Tako-Tsubo cardiomyopathy because of the way the left ventricle appeared on ventriculogram. The hypokinetic mid-ventricle and apex with a rounded bottom and narrow neck in systole resemble the traditional Japanese octopus trap for which it was named. ABS is also referred to as "stress" or "ampulla" cardiomyopathy, and as "the broken heart syndrome."
This cardiomyopathy is unique in that it is often precipitated by emotional or physical stressors including natural disasters, the sudden death of a loved one, serious medical illness, and noncardiac surgery. There have also been reports of professional sporting events triggering ABS. Because most patients in early publications were Japanese, ABS was initially thought to be a geographically isolated phenomenon with Asian descents. This cardiomyopathy has recently been documented in European, Australian, and North American patients, and the lack of prior reports in the western world may have simply been due to the lack of awareness of the disease entity. ABS is an emerging and under-recognized cardiomyopathy mimicking ST elevation infarct, and a high index of clinical suspicion is needed to correctly identify this transient cardiomyopathy.
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