Transient left ventricular apical ballooning.

http://ccn.aacnjournals.org Brenda McCulloch is a clinical nurse specialist for the Sutter Heart Institute in Sacramento, California. She has 25 years of experience in cardiovascular nursing, with a concentration in interventional cardiology. Transient left ventricular apical ballooning, also known as takotsubo cardiomyopathy, is an unusual abnormality that may be the underlying cause of signs and symptoms of acute myocardial infarction (AMI) in a small number of patients. The signs and symptoms include chest pain, ST-segment changes, and the release of cardiac biomarkers. Dyspnea and hypotension may also occur. Although these signs and symptoms are suggestive of AMI, they are not caused by ischemic coronary artery disease. This abrupt onset of extensive “ballooning” or dilatation of the left ventricle occurs most often in postmenopausal women after a traumatic psychosocial or physical stressor. Although its onset is sudden and dramatic, apical ballooning is transient and reversible. Its cause is not known. It is increasingly recognized and reported in the medical literature. Because apical ballooning mimics the signs and symptoms of AMI, emergency department and critical care nurses may care for patients with this interesting and uncommon abnormality. In this article, I review the pathophysiology, clinical features, management, complications, and prognosis of apical ballooning. Three case reports are included to illustrate the growing experience with this abnormality. Apical ballooning was first described in the Japanese literature in the early 1990s and was attributed to simultaneous spasm of multiple coronary arteries. The original name given to apical ballooning was takotsubo cardiomyopathy, which was derived from the shape of the narrow-necked bulging “takotsubo” container used by Japanese fisherman to trap octopus. The shape of the takotsubo pot resembles the distorted ballooning ventricle (Figure 1). Table 1 lists several other terms used in the medical literature to describe this ballooning. Additional reports of apical ballooning have come from many areas of the world, including Europe, Australia, South America, and the United States. Because of the increased recognition of this abnormality, in the International Transient Left Ventricular Apical Ballooning CoverArticle