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Apical ballooning syndrome

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Takotsubo-like cardiomyopathy (TC) is an enigmatic cardiomyopathy,characterised by a reversible left ventricular (LV) dysfunction triggered frequently by physical or emotional stress, mimicking an acute coronary syndrome (ACS)

  • characterised by transient wall-motion abnormalities involving apical and/or mid-portions or basal segments of the left ventricle in the absence of significant obstructive coronary disease or, conversely, in the presence of stenosis not related to the myocardial-involved region

  • affected patients are generally postmenopausal women, whose symptoms and ECG changes mimic an acute myocardial infarction (AMI)
    • however, the release of the myocardial enzyme is limited if compared with the extent of LV dysfunction
    • the ECG does not reproduce the typical evolution of an AMI because ST elevation or ST depression, prominent negative T waves with long QT interval, and Q waves disappear in the follow-up

  • the lack of history of cardiac disease, and the reversibility of ventricular dysfunction make this syndrome very difficult to explain from a pathophysiological point of view. Mortality and complication are extremely low if compared with either AMI-related in-hospital or out-of-hospital 1-year mortality

  • reports suggest that TC accounts for 1.5-2.2% of patients presenting with symptoms that initially appeared to be an ACS

  • has been estimated that as many as 6% of women presenting with an apparent ACS may actually have TC

  • the aetiology has yet to be defined

  • in the UK estimated that 2000-3000 per annum cases of TC


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