Apical ballooning syndrome or aborted acute myocardial infarction? Insights from cardiovascular magnetic resonance imaging

Abstract

While ABS mimics AMI, AMI with spontaneous clot lysis may also mimic ABS, and at least in some patients, be mistaken for ABS. ABS is characterized by the absence of MDE and complete myocardial viability on CMR. The diagnosis of ABS can be excluded if CMR demonstrates MDE consistent with myocardial necrosis in a pattern and distribution consistent with AMI.

A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings

“…Several studies have demonstrated that patients with takotsubo cardiomyopathy show no delayed hyper enhancement and transmural high signal intensity on the T2-weighted MR image involving the mid-anterior wall and apical segments and that match the distribution of hypokinesis [14,15]. Interestingly, Joshi et al [16] reported that patients who had follow-up MR imaging at 2-3 weeks showed normalization of the wall motion abnormalities associated with a significant reduction in the T2 signal intensity.…”

Takotsubo Syndrome and Acute Coronary Syndrome: Case Report and Literature Review

“…The incidence of this reversible cardiomyopathy is estimated to be 1%-2% of patients presenting with an acute myocardial infarction (AMI). AMI with spontaneous clot lysis may mimic TS (7,8).…”

Sudden cardiac death: An increasingly recognized presentation of apical ballooning syndrome (Takotsubo cardiomyopathy)

“…7 It is unlikely that VA in ABS is due to reentry from myocardial scar, as magnetic resonance imaging demonstrates an absence of delayed gadolinium hyperenhancement in virtually all patients. 8 The ECG of patients with ABS often demonstrates diffuse T-wave inversions and profound QTc prolongation that can persist for days, 9,10 potentially predisposing patients to torsades de pointes which can degenerate into VF. The risk of VA occurrence is directly related to the degree of QTc prolongation.…”