Korean J Radiol.  2007 Feb;8(1):74-77. 10.3348/kjr.2007.8.1.74.

Magnetic Resonance Imaging of Transient Left Ventricular Apical Ballooning Related to Emotional Stress: a Case Report

• Lee MS
• Choi BW
• Choe KO
• Chung N

• KMID: 753869
• DOI: http://doi.org/10.3348/kjr.2007.8.1.74

Abstract

Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function.

Keyword

Transient left venticular apical ballooning; Tako-tsubo cardiomyopathy; Magnetic resonance imaging (MRI)

MeSH Terms

Ventricular Dysfunction, Left/*diagnosis/*etiology
Stress, Psychological/*complications
Myocardial Infarction/diagnosis
Magnetic Resonance Imaging/*methods
Humans
Female
Electrocardiography
Echocardiography
Diagnosis, Differential
Aged

Figure

• 

  Fig. 1 A 66-year-old woman with transient left ventricular apical ballooning. A. The initial echocardiogram shows T-wave inversion in leads V3 through V6, and Q-wave in leads V4 through V6. B. The aortogram reveals left ventricular apical and mid-ventricular akinesis and basal hyperkinesis. C. The conventional coronary angiogram shows no obstruction of the right and left coronary arteries. D. The cine MR images in a four chamber view show severe hypokinesis of the left ventricular apical and mid-ventricle, which was slightly improved compared to that of the aortogram (B). E. The first-pass perfusion MR images in a short axis view at the apical level show no perfusion abnormality of the myocardium. The upper row images are not enhanced images and the lower row images are maximally enhanced images of the myocardium. F. The contrast-enhanced delayed images in a short axis view show no abnormal enhancement of the myocardium. G. The coronary MR angiograms show no significant stenosis of the left and right epicardial coronary arteries.

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