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Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report
Manju D Chandrasegaram, David S Celermajer, Michael K Wilson
Journal of Cardiothoracic Surgery , 2007, DOI: 10.1186/1749-8090-2-14
Abstract: We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect.Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg). Coronary angiography revealed no obstructive coronary lesions.She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well.This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The sequence of our patient's presentation suggests that the apical ballooning caused geometric alterations in her left ventricle that in turn led to acute and severe mitral regurgitation, systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction. The left ventricular outflow tract obstruction and mitral regurgitation were corrected by mechanical mitral valve replacement. We describe a variant of Takotsubo cardiomyopathy with acute mitral regurgitation, systolic ant
Apical ballooning syndrome after attempted suicidal hanging  [cached]
Chacko Jose,Brar Gagan,Elangovan Ashok,Moorthy Ramanathan
Indian Journal of Critical Care Medicine , 2011,
Abstract: We report a case of "Apical Ballooning Syndrome" following attempted suicidal hanging. Our patient developed retrosternal chest pain and ischemic changes on electrocardiography (ECG), a day after the suicidal attempt. She underwent an angiogram considering the possibility of acute coronary syndrome. However, her coronary arteries were normal; the left ventricle showed the typical ballooning pattern characterized by hypokinesia of the distal septum and apex. On follow-up a week later, she remained asymptomatic; her ECG changes had reversed and the left ventricular contractility was normal on echocardiography.
Apical Ballooning Syndrome: A Complication of Dual Chamber Pacemaker Implantation  [cached]
Raed A. H. Abu Sham'a,Elad Asher,David Luria,Michael Berger
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: Apical ballooning is a cardiac syndrome (Takotsubo Cardiomyopathy) described as a typical form of acute transient left ventricular dysfunction. While its onset has often been associated with emotionally or physically stressful situations, it has an overall favorable prognosis. We describe here a case of transient apical ballooning following permanent pacemaker implantation.
Síndrome de Tako-Tsubo. Reporte de un caso con atipicidades. Tako-Tsubo syndrome. A case report with atypical features.
Marcos V. Dopaso Alonso,Tania Guerrero González,Raymid García Fernández,Juan Valiente Mustelier
Revista Cubana de Cardiología y Cirugía Cardiovascular , 2011,
Abstract: The Tako-Tsubo syndrome is a reversible form of an acute stress-related cardiomyopathythat was recently described. It typically presents with a constellation of symptoms, electrocardiographicchanges, elevated cardiac enzyme levels and echocardiography imaging consistentwith an acute coronary syndrome. However, when the patient undergoes cardiac angiography,left ventricular apical ballooning finding is seen, but no significant coronary arterystenosis. This ballooning-like morphology, being the hallmark of this entity, can be detectedby imaging. We present a case report in a patient who was admitted to our hospital and metall the diagnostic criteria of the Tako-Tsubo syndrome, but with some atypical features.
Apical Ballooning Syndrome (Takotsubo Cardiomyopathy) after Permanent Dual-Chamber Pacemaker Implantation  [PDF]
Armando Gardini,Francesco Fracassi,Emiliano Boldi,Remo Albiero
Case Reports in Cardiology , 2012, DOI: 10.1155/2012/308580
Abstract: Apical ballooning syndrome, also called takotsubo cardiomyopathy, has been recently reported. It may mimic acute myocardial infarction and is typically observed in postmenopausal women after stressful events. A 75-year-old female after permanent dual chamber pacemaker implant complained of chest pain with repolarization alterations suggesting acute myocardial ischemia. Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function. The patient was treated with antithrombotic agents and intravenous nitrates. No coronary lesions were found at angiography. At ventriculography, a typical takotsubo-like shape of the left ventricle was observed. The clinical and echocardiographic picture normalized at discharge. 1. Introduction Apical ballooning syndrome (ABS) has been reported since the 1990s in Japan [1]. The clinical presentation mimics acute myocardial infarction (AMI) and is characterized by chest pain and or dyspnoea, ST segment elevation, mild cardiac enzymes increase, transient left ventricular systolic dysfunction with hypokinesia of the middle and distal portions of the left ventricle (LV) and hyperkinesia of basal segments, and absence of coronary artery lesions. It typically affects postmenopausal women, and the prognosis is usually favourable. An emotional or physical stressful event often precedes the clinical picture [2–4]. We describe a case of ABS which occurred after permanent pacemaker implantation. 2. Case Report A 75-year-old woman with history of hypertension and no previous cardiac symptoms was admitted for syncope and paroxysmal third-degree atrioventricular (AV) block. Preoperative evaluation revealed normal haematological tests, chest X-ray, and echocardiography. The EGC presented first-degree AV block, right bundle branch block, and left anterior fascicular block. A dual-chamber pacemaker (PM) with ventricular lead in the right ventricle (RV) apex was then implanted without procedural complications. On the night following the implant, the patient complained of repeated self-limited episodes of interscapular pain with mild dyspnoea. The day after the ECG showed sinus rhythm triggering PM ventricular stimulation with ST segment elevation in inferior and anterior leads. PM inhibition showed the preexisting intraventricular conduction disturbance with inferior and anterior ST segment elevation (Figure 1). Chest X-ray excluded pneumothorax. At echocardiogram, akinesia of the apical portions of the LV with reduced LV systolic function was observed. Cardiac biomarkers were slightly
A Rare Case Report of Mid Cavitary Takotsubo: The Role of Magnetic Resonance Imaging
Jesse Sherratt,Carolyn E. McDonald,Gerald York,Ahmad Slim
Case Reports in Cardiology , 2011, DOI: 10.1155/2011/481394
Abstract: This is a case report of a female presenting originally with clinical picture of acute coronary syndrome and depressed left ventricular function with no angiographic evidence of coronary artery disease with mid cavitary akinesis and basal as well as apical hyperkinesis after emotional stresses identified by multi-imaging modalities to be mid cavitary Takotsubo. The Incidence and the prevalence of apical ballooning syndrome (Takotsubo) is on the rise with more reports in the literature; however, mid cavitary Takotsubo remains rare and raises questions more than answers as to the reason behind the mid cavitary localization in some patients versus apical involvement.
Cardiac Magnetic Resonance Imaging in the Diagnosis of Anterolateral Left Ventricular Ballooning, a Variant of Classic Takotsubo Cardiomyopathy  [PDF]
R. Zbinden,M. Mutter,D. Weishaupt
Case Reports in Cardiology , 2012, DOI: 10.1155/2012/537169
Abstract: Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks. 1. Introduction Transient left ventricular apical ballooning syndrome characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis was first described as Takotsubo-type cardiomyopathy in 1990 [1]. It was named for its distinctive appearance of the ventriculogram similar to the Japanese fishing instrument used for trapping octopuses, called Takotsubo. Takotsubo cardiomyopathy (TTC) is characterized by acute, profound, but reversible left ventricular (LV) dysfunction in the absence of significant coronary artery disease, triggered by acute emotional or physical stress. This phenomenon is identified by a distinctive pattern of “apical ballooning” and primarily affects postmenopausal women [2]. The majority of patients have a clinical presentation similar to that of acute coronary syndrome (ACS). TTC or stress-induced cardiomyopathy is a clinical syndrome which has been described only very recently and has been increasingly recognized outside Japan during the last few years. Diagnostic criteria are still vague; this is mainly due to the lack of knowledge about the etiology of TTC. Several mechanisms have been discussed such as multivessel epicardial spasm [3], catecholamine-induced cardiomyopathy [4], or microvascular dysfunction induced by mental stress [5]. We report the case of a stress-induced left ventricular anterolateral ballooning in a 61-year-old female patient matching the diagnostic criteria of TTC but with a distinct pattern of ballooning/dyskinesia. 2. The Case The 61 year old female patient presented the day after new years eve with typical anginal chest pain at rest with radiation to the jaw. The ECG at presentation showed minimal ST-elevation (0.5?mm) in I and aVL and poor R wave progression V1–V4. Regarding cardiovascular risk factors the patient had mild hypertension and dyslipidemia (currently not treated).
Neurogenic Stunned Myocardium Associated with Acute Spinal Cord Infarction: A Case Report  [PDF]
Gillian A. Beauchamp,Jason T. McMullan,Jordan B. Bonomo
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/439528
Abstract: Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia. 1. Introduction Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning which has been described to occur in the setting of catecholamine release [1, 2] during situations of physiologic stress such as subarachnoid hemorrhage [3–5], reversible posterior leukoencephalopathy [6], atrial fibrillation [7], hemorrhagic cerebral contusion [8], status epilepticus [9], ischemic cerebrovascular accident [10], limbic encephalitis [11], and severe emotional stress [12]. NSM has also been referred to as “broken heart syndrome” [12], “takotsubo cardiomyopathy,” “apical ballooning syndrome,” “neurogenic stress cardiomyopathy,” [13] and “transient left ventricular dysfunction syndrome.” [14] This condition typically presents with mildly elevated cardiac biomarkers [14] and reversible regional-wall motion abnormalities on echocardiogram [15]. Care for NSM involves treatment of the underlying cause and supportive care. Acute spinal cord ischemia is a rare ischemic vascular lesion with high morbidity and mortality [16]. To the best of our knowledge, this is the first case report of the occurrence of neurogenic stunned
Síndrome de discinesia apical transitoria: Presentación de 1caso Transient apical dyskinesia syndrome: A case report  [cached]
Javier Cecilio Céspedes Suárez,Janzel Pérez Marrero,Javier Almeida Gómez,Orlando álvarez Toledo
Revista Cubana de Medicina , 2007,
Abstract: Se realizó la presentación clínica de una paciente de 55 a os posmenopáusica con síntomas clínicos de insuficiencia cardíaca y diagnóstico de mixoma auricular por lo que fue intervenida quirúrgicamente. En el posquirúrgico presentó signos electrocardiográficos y ecocardiográficos de infarto agudo del miocardio con disfunción del ventrículo izquierdo por lo cual se le realizó una coronariografía que resultó normal. Se recuperó de forma satisfactoria, tanto clínica como ecocardiográficamente. Se concluyó que se trataba de un síndrome de discinesia apical del ventrículo izquierdo del cual no tenemos referencias previas de su existencia en nuestro país. The case of a 55-year-old postmenopausal female patient with clinical symptoms of heart failure and diagnosis of atrial myxoma that made her underwent surgery, was reported. In the postsurgical, she presented electrocardiographic and echocardiographic signs of acute myocardial infarction with disfunction of the left ventricle. A coronariography that proved to be normal was peformed. A left ventricle apical dyskinesia syndrome was confirmed, of which there were no previous references in our country.
Recurrent Stress-Induced Cardiomyopathy: A Case Report and Review Article
Suman krishna Kotla,Cyril Nathaniel
Case Reports in Medicine , 2011, DOI: 10.1155/2011/160802
Abstract: ABS is a unique acute cardiac syndrome and a recently recognized form of transient left ventricular dysfunction. It mimics ACS in clinical presentation (chest pain and dyspnea) and specific ECHO findings in the absence of significant coronary lesions. This rare entity accounts for 2.2% of ST segment elevation ACS. Pathophysiology mostly correlates to stress-induced catecholamine release. The syndrome is predominant in females, mostly in the postmenopausal age group. It should be initially managed according to the guidelines of ACS. The prognosis for apical ballooning syndrome is generally favorable with inpatient hospital mortality less than 2%. Reports of a single episode of ABS are common in recent medical literature; we report a rare case of recurrence that provides more insight into the nature of this unique syndrome.
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