Transient left ventricular apical ballooning: A unifying pathophysiologic theory at the edge of Prinzmetal angina
- 15 February 2008
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 71 (3), 342-352
- https://doi.org/10.1002/ccd.21338
Abstract
Introduction: Takotsubo or ampulla transient left ventricular apical ballooning (LVAB) cardiomyopathy has been described as a clinical syndrome characterized by the sudden onset of chest pain, cardiac failure, ischemic changes on electrocardiography, and apical severe myocardial dysfunction in the presence of “normal” coronary arteries on angiography. All features last from a few days to a few weeks. Methods and Results: On the basis of previous knowledge and in light of our recent experience with acetylcholine testing in this condition, the cases of four patients are described and preliminary but sound arguments are given to support the theory that LVAB is caused by severe, sustained spasm of many or all of the coronary vessels. In one of these patients, experimental reproduction of LVAB occurred in the catheterization laboratory during acetylcholine testing (as evidenced by echocardiographic monitoring), while in two other patients, the test provoked similar, extensive angiographic vasospasm and suggestive symptoms. In addition, the similarities and differences that exist between LVAB and Prinzmetal angina are discussed. Conclusion: To evaluate the pathogenesis of LVAB, it is proposed that acetylcholine testing be routinely performed under specific, prospective, investigational protocols at specialized centers.Keywords
This publication has 33 references indexed in Scilit:
- Myocardial perfusion in apical ballooning syndrome: Correlate of myocardial injuryAmerican Heart Journal, 2006
- Myocardial Stunning Due to Sudden Emotional StressNew England Journal of Medicine, 2005
- Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attackJournal of the American College of Cardiology, 2004
- Tako-Tsubo Transient Left Ventricular Apical Ballooning Is Associated With a Left Anterior Descendig Coronary Artery With a Long Course Along the Apical Diaphragmatic Surface of the Left VentricleRevista Española de Cardiología (English Edition), 2004
- Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarctionJournal of the American College of Cardiology, 2001
- Increased responsiveness of left ventricular apical myocardium to adrenergic stimuliCardiovascular Research, 1993
- Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasmJournal of the American College of Cardiology, 1988
- alpha-Adrenergic receptors and coronary spasm: an elusive link.Circulation, 1984
- The stunned myocardium: prolonged, postischemic ventricular dysfunction.Circulation, 1982
- Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography.Circulation, 1982