Unusual case of left ventricular ballooning involving the inferior wall: a case report

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Abstract

Abstract
Background: Tako - tsubo like syndrome (also named left ventricular apical ballooning) is an unusual cardiomyopathy with an high incidence in Japanese population of female sex, following an emotional stress. The clinical features (typical chest pain), and the electrocardiographic changes (negative T wave and persistent ST elevation in anterior leads), are suggestive of an acute myocardial infarction; nevertheless the coronary angiography show coronary arteries without lesions and the ventriculography show specific segmental dysfunction. In the literature there are many reports of typical left ventricular ballooning (apical); due to the rarity of the atypical localizations (such as mid, basal, anterior or inferior left ventricular wall) many authors think they are different physiopatologic entity. Case report: We report a case of 50 ├óÔé¼ÔÇ£ years old woman, with a family history of ischeamic cardiomyopathy but with no additional cardiovascular risk factors, who arrived to emergency department with a recent episode of chest pain (about 30 minutes) with electrocardiographic and echocardiographic features suggested of a inferior ST elevation myocardial infarction. Coronary angiography showed coronary arteries without atherosclerotic lesions; ventriculography showed an inferior dysfunction.

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Conclusions: This data can suggest for an atypical form (in term of clinical presentation and localization) of left ventricular ballooning involving the inferior wall (never described in the literature), not preceded by any emotional or physical stress. The follow ├óÔé¼ÔÇ£ up performed by transthoracic echocardiography (2 months later) revealed a complete regression of wall motions abnormalities.

Background
The left ventricular ├óÔé¼┼øapical ballooning├óÔé¼┼Ñ syndrome, also known as ├óÔé¼┼øTako - Tsubo like syndrome├óÔé¼┼Ñ, has recently been the subject of numerous studies and reports in the literature, to the point that the term ├óÔé¼┼østress-induced cardiomyopathy├óÔé¼┼Ñ [1] has been coined. It was initially described by Japanese authors in the early Nineties (hence the name Tako - tsubo, because of the characteristic shape assumed by the left ventricle in telesystole, wholly similar to that of octopus traps in Japan) and its clinical presentation in most cases mimics acute myocardial infarction; in the past five years, several European, American and Australian cases have also been reported in the literature [2, 3].

The incidence of the pathology is estimated to be approximately around 1% - 2% among all patients who come under cardiological attention for acute ischemic events (both acute coronary syndrome and acute myocardial infarction); according to a recent statistic by the American Heart Association, out of 732,000 yearly dismissals of patients with a primary diagnosis of acute myocardial infarction, a number varying between 7,000 and 14,000 patients may present stress-induced cardiomyopathy [4]. However, an accurate estimate of incidence is not feasible because of its recent definition, disparate clinical presentations and constant evolution.

  Figure 1
electrocardiogram at the admission

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