Stress induced apical ballooning has been described as a reversible condition involving the apical left ventricular wall, sparing the base, and causing a ballooning appearance of the left ventricular during systole despite normal coronaries. However, there are no data about early diagnosis of Apical ballooning syndrome using echocardiography.
We are presenting four cases of apical ballooning seen at our institution with echocardiographic correlation. We compared angiogram with echocardiographic finding prior to angiogram.
All Echocardiograms showed similar anatomical apical ballooning of the left ventricular apex. The diagnosis of apical ballooning syndrome was suspected based on echocardiography in conjunction with clinical data before cardiac catheterization was performed. In one case, in addition to classic left ventricular apical ballooning, marked right ventricular apical akinesia was present on the initial echocardiographic examination Subsequent angiograms in all patients showed classic apical ballooning and normal coronaries.
Apical ballooning syndrome can be suspected based on classic echocardiographic findings and clinical data prior to angiography.
Therefore, we suggest that echocardiography should be utilized more for the early diagnosis of this disease based on careful anatomical evaluation in conjunction with clinical data. Wall motion analysis should reveal apical ballooning appearance involving many coronary territories with discrepancy to electrocardiogram and cardiac enzyme elevation. Furthermore, the additional presence of right ventricular apical akinesia during echocardiographic examination makes the diagnosis of this syndrome more likely.
Daniel Donohue, None.