Dynamic LV obstruction in apical ballooning syndrome: The chicken or the egg

Abstract

Please see page 53 for the article by Merli et al. (doi: 10.1016/j.euje.2005.08.003 ) to which this editorial pertains. Between 1990 and 2001 several cases of a new heart syndrome have been reported in Japan, all in Japanese journals. This syndrome consisted of acute onset, transient left ventricular apical wall motion abnormalities with chest symptoms, electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction in patients without significant stenosis on coronary angiogram. It was named “Tako-tsubo” – shaped cardiomyopathy due to its unique “short neck round – flask” – like left ventricular apical ballooning resembling the Tako-Tsubo (Japanese for octopus pot or trap) of Japan. These reports received little or no attention in Western literature, until in 2001 a series of 88 patients were published,1 retrospectively enrolled from cardiovascular institutes of Angina Pectoris–Myocardial Infarction investigations in Japan. In addition to describing symptoms and electrocardiographic and hemodynamic findings, this publication suggested that emotional or physical stress might play a key role in this acute cardiomyopathy since in a majority of cases a preceding aggravation of underlying disorders or acute emotional and physical problems could be identified. Because until then virtually all reports had been confined to Japanese patients, many Western cardiologists believed that it concerned a geographically restricted cardiovascular syndrome, if not a misinterpretation of rare cases of aborted anterior myocardial infarction or variant angina. But in 2003, a first European series of 13 white patients were described,2 underscoring that this syndrome also exists outside Japan. Again the complete recovery of left ventricular function within three weeks was reported, despite the sometimes dramatic initial presentation. It was now obvious that clinicians in the Western world should also be aware of the existence of this syndrome because this syndrome mimicking acute myocardial infarction may inadvertently expose patients to futile …