Apical Ballooning Apical Ballooning SyndromeSyndromeBy: Adam P. LightBy: Adam P. Light

Apical Ballooning is:Apical Ballooning is:

A phenomenon where the anterior wall of the left ventricle of the heart loses it’s ability to squeeze for a short period of time. Not caused by a myocardial infarction. First diagnosed in 1990.

Also Know As (AKA)Also Know As (AKA)

• Apical ballooning syndrome• Tako-Tsubo• Broken heart syndrome• Reversible cardiomyopathy• Stress-induced cardiomyopathy• Regional Systolic dysfunction• Ampulla cardiomyopathy• Transient left ventricle apical ballooning

Who Does it AffectWho Does it Affect

Men and women are both affected by this disorder. However, women are said to present 6.3-fold higher than males. Also, post menopausal females are affected more so than pre menopausal females.

What are the signs and symptomsWhat are the signs and symptoms

Symptoms resemble an acute myocardial infarction.

• Shortness of breath• Chest Pain • EKG changes with ST-elevation• Changes in cardiac enzyme levels• Hemodynamic instability• Cardiogenic shock

What causes this disorder?What causes this disorder?

Although professionals are not sure why this abnormality happens, researches have linked a majority of the cases to posttraumatic stress.

Another possible manifestation of Another possible manifestation of apical ballooning syndromeapical ballooning syndrome

It is believed that this phenomenon can be brought on by physiological stress. Such as news of life altering medical complications i.e. stroke or cancer.

TreatmentTreatment

Treatment for this form of cardiomyopathy is still under investigation. For now medical treatment consists of medicines used to treat myocardial infarction.

• Aspirin• Beta-blockers• Diuretics• Angiotensin-converting enzyme inhibitors• Calcium channel blockers• Vasopressors• Anticoagulants• Inta-aortic balloon pump (IABP)

PrognosisPrognosis

Most patients have a full recovery of their left ventricle within 2-6 weeks, with only a mortality range of 0%-8%.

Why more females?Why more females?

It is believed, but not proven, that females release different enzymes than males, making them more susceptible. Also, females are believed to handle stress differently than males.

Case studyCase study

A case study was performed on a female Caucasian 46 years of age. The patient was presenting with a myocardial infarction, or was she?

Patient HistoryPatient History

• Chest Pain

• EKG changes in leads V3-V6

• No known previous coronary artery disease

• Normal heart sounds

• Chest pain followed news of mothers illness

• Family history of CAD was present

TreatmentTreatment

• Pt received an emergent cardiac catheterization

• Coronaries were completely normal angiographically

• Ejection fraction was 30%

• Received meds: Beta-blockers and aspirin

• Hospitalized for 3 days

Follow upFollow up

Patient was seen at The Heart Center with Cardiovascular Associates. A nuclear stress test, echocardiogram, fasting lipid profile, and comprehensive metabolic panel were performed.

OutcomeOutcome

• All lab work was within normal limits

• Stress test was normal

• Echocardiogram was read with an ejection fraction of 60%

ConclusionConclusion

Apical ballooning syndrome is a serious but recoverable form of cardiomyopathy. With continued research we can stop the breaking of hearts.

Case study left ventricle angiogramCase study left ventricle angiogram