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ransient left ventricular apical ballooning [1][2][3][4][5][6] in patients with normal coronary angiography results is characterized by transient left ventricular (LV) dysfunction and chest symptoms, together with electrocardiographic (ECG) changes that mimic those of acute myocardial infarction (AMI). Generally, the prognosis for transient LV apical ballooning is good, because in most patients ventricular function improves with conservative therapy. Nevertheless a very small number die from cardiogenic shock. We report a patient, treated for transient LV apical ballooning, who died from LV free wall rupture. Such an occurrence has not been reported previously in association with transient LV apical ballooning. Case ReportA 79-year-old woman was admitted to hospital in September 2003 with sudden onset of chest pain. Her level of consciousness was clear, her pulse rate was 84 beats/min, and blood pressure was 124/80 mmHg. Auscultation of the heart and lungs was normal. An ECG showed sinus rhythm with ST-segment elevation in leads I, aVL and V1-5, depression in leads III and aVF, and abnormal Q wave in leads V1-4 (Fig 1). Echocardiogram at the time of admission revealed akinesis in the LV apical wall. Laboratory data showed increased creatine kinase concentration (768 IU/L). An acute AMI was suspected, and the patient underwent emergency cardiac catheterization. However, coronary angiography did not reveal a stenotic lesion in any coronary artery (Fig 2A,B) (Fig 2C,D), and the LV ejection fraction was 31%. A diagnosis was subsequently made of transient LV apical ballooning, and she was only treated with diuretics.On the fifth day following admission, another ECG indi-

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