It is called also Apical Ballooning Syndrome (ABS) and Tako tsubo cardiomyopathy. It is first described by Dote in Japan 1991.
It is an acute onset reversible dilated cardiomyopathy. It occurs mainly in women after menopause, 6.3 fold more in women than men, with incidence rate of 1-3 % of patient admitted with heart attack (STEMI).
What are the main symptoms?
The patient usually presents with:
Diagnostic points are four:
There is no clear cut pathophysiology but the most favourable explanation is catecholamine mediated myocardial stunning(stressful event), we have to think about microvascular spasm which is one type of ischemia without significant stenosis in an epicardial artery. This novel heart syndrome might be one of the clinical Models of stress-related sudden death.
Regional apical ballooning.. Why apex??
Some anatomic and physiologic factors may contribute to left ventricular apical wall motion abnormality:
1 – LV apex does not have a three layer myocardial structure.
2 – Easy loss of elasticity of LV apex after excessive expansion.
3 – Apex is the border zone of the perfusion area of major coronary arteries
4 – The delay of functional recovery from global dysfunction.
Rare Ventricular free wall rupture – VSD – thromboembolic events related to LV hypokinesia or dyskinesia may also occur.
Overall in hospital mortality rate is 1-3 % mainly from cardiogenic shock or systemic embolization but generally are much lower than from other acute cardiac illness.
The cardiologist will manage the situation depending on the clinical situation, the blood pressure, the pulse, the accumulation of fluid in the chest, and so on. However supportive treatment leads to spontaneous rapid recovery in nearly all patients.
Recovery and outcome
Recovery starts usually after 3 days and it takes a few weeks to a few months but, anyway, the end result is excellent. The in-hospital death is 1-3 % and the recurrent rate is 1-2 % during one year.
Dubai Cardiology Clinic - Treatment of various cardiovascular diseases such as Hypertension, Ischemic heart disease, Holter monitoring, Heart failure, Stress test, chest pain and echocardiography are now available in DRHC.