1. Apical Ballooning Syndrome By: Adam P. Light

2. Apical Ballooning is: A phenomenon where the anterior wall of the left ventricle of the heart loses it’s ability to squeeze for a short period of time. Not caused by a myocardial infarction. First diagnosed in 1990.

3. Also Know As (AKA) Apical ballooning syndrome Tako-Tsubo Broken heart syndrome Reversible cardiomyopathy Stress-induced cardiomyopathy Regional Systolic dysfunction Ampulla cardiomyopathy Transient left ventricle apical ballooning

4. Who Does it Affect Men and women are both affected by this disorder. However, women are said to present 6.3-fold higher than males. Also, post menopausal females are affected more so than pre menopausal females.

5. What are the signs and symptoms Symptoms resemble an acute myocardial infarction. Shortness of breath Chest Pain EKG changes with ST-elevation Changes in cardiac enzyme levels Hemodynamic instability Cardiogenic shock

6. What causes this disorder? Although professionals are not sure why this abnormality happens, researches have linked a majority of the cases to posttraumatic stress.

7. Another possible manifestation of apical ballooning syndrome It is believed that this phenomenon can be brought on by physiological stress. Such as news of life altering medical complications i.e. stroke or cancer.

8. Treatment Treatment for this form of cardiomyopathy is still under investigation. For now medical treatment consists of medicines used to treat myocardial infarction. Aspirin Beta-blockers Diuretics Angiotensin-converting enzyme inhibitors Calcium channel blockers Vasopressors Anticoagulants Inta-aortic balloon pump (IABP)

9. Prognosis Most patients have a full recovery of their left ventricle within 2-6 weeks, with only a mortality range of 0%-8%.

10. Why more females? It is believed, but not proven, that females release different enzymes than males, making them more susceptible. Also, females are believed to handle stress differently than males.

11. Case study A case study was performed on a female Caucasian 46 years of age. The patient was presenting with a myocardial infarction, or was she?

12. Patient History Chest Pain EKG changes in leads V3-V6 No known previous coronary artery disease Normal heart sounds Chest pain followed news of mothers illness Family history of CAD was present

13. Treatment Pt received an emergent cardiac catheterization Coronaries were completely normal angiographically Ejection fraction was 30% Received meds: Beta-blockers and aspirin Hospitalized for 3 days

14. Follow up Patient was seen at The Heart Center with Cardiovascular Associates. A nuclear stress test, echocardiogram, fasting lipid profile, and comprehensive metabolic panel were performed.

15. Outcome All lab work was within normal limits Stress test was normal Echocardiogram was read with an ejection fraction of 60%

16. Conclusion Apical ballooning syndrome is a serious but recoverable form of cardiomyopathy. With continued research we can stop the breaking of hearts.

17. Case study left ventricle angiogram