Abstract
myocardial infarction. We described two cases of apical ballooning postmenopausal women patients presented with picture of acute coronary syndrome. Case 1: A 71-year-old woman with past medical history significant for chronic obstructive pulmonary disease, presented emergency department with acute onset of retrosternal chest pain. Her husband had died 4 months ago. Physical examination was normal. Electrocardiogram revealed anterior ST-segment elevation and T-wave inversion with troponin level of 2.24ng/ml (normal <0.4). She was treated with aspirin, low molecular weight heparin, metoprolol, and nitroglycerin. Transthoracic echocardiogram revealed ejection fraction 40% and apical dyskinesis. Subsequently she underwent left heart catheterization which showed normal coronary arteries, apical ventricular akinesis. Follow up echocardiogram after one month revealed normal. Case 2: A 75-year-old woman, with no history of cardiac disease presented to emergency department with severe chest pain. Electrocardiogram revealed anterior ST-elevation with minor myocardial enzymes release. Physical examination revealed blood pressure of 82/62mmHg, heart rate of 98/min. After receiving dopamine perfusion she did not stabilize. Emergency cardiac catheterization disclosed left ventricular apical ballooning in spite of normal coronary arteries. On return to medical intensive care unit, dopamine perfusion continued and the patient was stabilized within 2 days. The echocardiogram showed apical akinesis. Conclusion: Apical balloning syndrome is an increasingly diagnosed acute cardiomopathy that can mimic acute coronary synrome at presentation. By most estimates, approximately 1% to 2% of all patients presenting with an initial primary diagnosis of myocardial infarction have ABS. ABS exclusively seen in postmenopausal women. It should be included in the differential diagnosis of patients with an apparent acute coronary syndrome with regional wall motion abnormality and absence of obstructive coronary artery disease.
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