Purpose Left ventricular apical ballooning (LVAB) is characterized by cardiac wall motion abnormalities involving the apex and midventricular segments in absence of obstructive coronary disease. It is easily mistaken for acute MI because it presents with symptoms mimicking acute MI. We report several cases with atypical clinical presentations and complicated hospital courses to better describe this recently reported cardiomyopathy.
Methods We analyzed medical records from patients who were diagnosed with an acute MI and then later found to have normal coronary vessels on cardiac catheterization. The data abstracted include (1) details of the inciting event, (2) ECG changes, (3) cardiac enzyme levels, (4) echocardiogram results, and (5) details of the hospital course. We included only patients with characteristic wall motion abnormalities involving the apex and/or midventricular segments and no evidence of obstructive coronary disease.
Results We identified five cases, all female, with an age range of 48 to74. One case presented after extensive abdominal surgery, one to the ER with chest pain, one after physical threat to life, one post-cardiac arrest, and one after a dobutamine stress test. All patients were evaluated for acute MI. They had either ST segment elevation (3/5), elevated troponin T levels, or both. Two patients had nonspecific ECG changes. The troponin T levels ranged from 0.15 to 0.93 ng/mL. Catheterization revealed patent epicardial coronary vessels and left ventricular apical dyskinesis or akinesis and normal or hypercontractile midventricular or basal segments. The wall motion abnormalities resolved spontaneously within a few days as documented by echocardiography. Three patients had complicated courses. The lengths of stay ranged from 2 to 18 days. All survived.
Conclusion Our patients demonstrate that LVAB syndrome can occur in diverse clinical settings that usually involve significant stress, emotional or disease related. Only one patient had a typical outpatient presentation with chest pain. In addition, three patients had complicated hospital courses. Clinicians need to maintain a high index of suspicion to identify these patients. Echocardiography is an important screening tool.
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