Stress Cardiomyopathy: A Case of Apical Ballooning Syndrome followed by Mid-ventricular Ballooning Syndrome as Recurrence

Abstract

Stress cardiomyopathy has an association with emotional or physical stressors and is found to be more common in postmenopausal women. It has a similar presentation as acute myocardial infarction. Involvement of apex at the initial presentation and recurrence at the mid ventricular segment is rare. We describe a case of a 46 year old female with apical involvement at the initial presentation but mid ventricular involvement at the recurrence. 46 year old woman developed sharp chest pain while giving awards at an honors assembly. She was brought to the ER and was found to have a troponin level elevation without any EKG changes. Cardiac cath did not show coronary artery disease. ECHO revealed a low EF of 30 % with apical ballooning. Patient's symptoms resolved and her EF normalized on repeat ECHO. 2 years later patient developed similar symptoms. She had a troponin elevation without EKG changes. ECHO revealed mid-ventricular ballooning with a low EF. Patient's symptoms again resolved and repeat ECHO showed a normalized EF. Our patient had two different episodes of stress cardiomyopathy. Recurrence rate has been reported up to 11.4 percent in previous studies (5). This case is unique as recurrence was at different anatomic locations i.e apex followed by the mid ventricular segments. Further research is needed to understand the underlying mechanisms associated with the stress cardiomyopathy as current hypothesis do not completely explain the disease.