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Heart 89:974-976 doi:10.1136/heart.89.9.974
  • Editorial

Apical ballooning of the left ventricle: a distinct entity?

  1. Y Abe,
  2. M Kondo
  1. Division of Cardiology, Shimada Municipal Hospital, Shimada City, Shizuoka, Japan
  1. Correspondence to:
    Makoto Kondo, MD, Division of Cardiology, Shimada Municipal Hospital, 1200-5 Noda, Shimada City, Shizuoka, 427-8502 Japan;
    kondo-m{at}gb3.so-net.ne.jp

    Primary transient left ventricular apical ballooning is a distinct entity that has been diagnosed worldwide. Although neurogenic stunned myocardium has often been suggested as the cause, further investigation is recommended

    Transient left ventricular apical ballooning is a syndrome presenting a unique morphologic feature of the left ventricle, characterised as a reversible balloon-like left ventricular wall motion abnormality at the apex with hypercontraction of the basal segment (fig 1). This entity was introduced as “tako-tsubo-like left ventricular dysfunction” in 1990 by Satoh and colleagues, and several reports have followed in Japan.1–5 “Tako-tsubo” is a fishing pot with a round bottom and narrow neck, which is used for trapping octopuses in Japan.4 However, establishment of its name, aetiology, criteria, management, and outcome remain challenging tasks.

    Figure 1

    Left ventriculogram during the acute and chronic phase. Reversible balloon-like asynergy at the apex with hypercontraction of the basal segment of the ventricle was observed during the acute phase and disappeared during the chronic phase. The interval between left ventriculograms from acute to chronic phase was 51 days.

    Recently, we reported the clinical features in this syndrome.5 The median age of our patients was 74 years, and 82% of patients were female, consistent with previous studies.2–4,6 Almost all patients had physical or emotional stress as triggering factors with minimum evidence of coronary risk factors. On ECG, ST-T segment elevation or inverted T waves with a prolonged QTc interval were observed in several leads during the acute phase and returned to normal during chronic phase.5 Because …