Angiographic long-term follow-up of primary apical ballooning of the left ventricle

Abstract

Acute and reversible left ventricular apical wall motion abnormalities presenting with chest pain, electrocardiographic (EKG) changes and cardiac markers release, in the absence of coronary artery stenosis, have already been identified as a possible distinct clinical entity: the so-called Tako-Tsubo syndrome. A 65-year-old man with history of hypertension, hypercholesterolemia and smoking, was admitted at the emergency room of a secondary referral institution with a severe and prolonged (45 min) chest pain, irradiated to the left arm, associated with neurovegetative syndrome. The clinical presentation suggested an acute myocardial infarction (AMI). Interestingly no coronary artery stenoses or vasospasm reaction to administration of acetylcholine could be detected. A slow flow phenomenon was present. The left ventricle angiography confirmed a mild depression of left ventricle systolic function (EF 45%), with akinesia of antero-lateral wall and the typical apical ballooning-like profile. At 3-month follow-up, the patient continued to be asymptomatic and the echocardiogram showed a progressive normalization of left ventricle segmental motion and ejection fraction with a complete restoration only after 6 months. At 1 year the coronary angiography confirmed the absence of coronary stenosis, with complete regression of the ventricular apical ballooning at left ventricle catheterization. At two-year follow-up the patient is still asymptomatic. A slow resolution of the syndrome should be included in the diagnostic criteria for apical ballooning.

TakoTsubo Cardiomyopathy A Short Review

“…in 1990 [1]. Some investigators reported prolonged spasm in multiple coronary arteries in patients with TCM, induced by both hyperventilation and provocative tests [22, 23]. However, only 28% of the TCM patients developed multivessel spasm on provocative tests [4], and the fact that the regional hypo/akinesis of the LV involves more than one coronary artery territory, mitigates against this possibility.…”

Takotsubo cardiomyopathy: a diagnostic challenge

“…Other ECG findings include reduction in R wave amplitude or loss of R wave in the anterior chest leads, and QTc interval prolongation 41. The ECG cannot reliably confirm or exclude the diagnosis, but the ST segment shift is usually less pronounced in comparison to STEMI 60.…”

Takotsubo cardiomyopathy — The current state of knowledge

“…However, the clinical data are conflicting. Some authors have demonstrated multivessel coronary spasm [22][23][24] while others could not confirm spasm as a cause of TTC [25,26]. The positive findings in the provocation tests for coronary vasospasm were less observed in TTC patient.…”