Article ID Journal Published Year Pages File Type
2934771 International Journal of Cardiology 2008 10 Pages PDF
Abstract

BackgroundTransient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease.MethodsSearching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms.ResultsTLVABS is observed in 0.7–2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2–93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0–86.7%) and dyspnea (20.4%, 95% CI: 16.3–24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2–75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8–89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20–49.9% to 59–76% within a mean time of 7–37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5–2.8%), complete recovery in 95.9% (95% CI: 93.8–98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation.ConclusionTLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.

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