Korean Circ J.  2008 Dec;38(12):677-680. 10.4070/kcj.2008.38.12.677.

A Unique Case of Transient Midventricular Ballooning: An Atypical Manifestation of Stress-Induced Cardiomyopathy Involving Both Ventricles

• Park HE
• Kim JH
• Yoon YE
• Park JB
• Lee W
• Cho Y
• Heo EY
• Kim HK
• Kim YJ
• Sohn DW

• KMID: 2225703
• DOI: http://doi.org/10.4070/kcj.2008.38.12.677

Abstract

Stress-induced cardiomyopathy is characterized by reversible systolic dysfunction of the ventricles, usually involving the apical segments. It occurs more commonly in women and is frequently precipitated by emotional or physical stressors. Ever since the first report of typical stress-induced cardiomyopathy-usually known as Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome-was issued, variant forms of stress-induced cardiomyopathy have been reported. We describe a patient who presented with typical ischemic chest pain, but who was found to have an atypical form of stress-induced cardiomyopathy: midventricular ballooning syndrome involving both the left and right ventricles. Transthoracic echocardiography and computed tomography were used in this patient.

Keyword

Takotsubo cardiomyopathy; Echocardiography; Computed tomography

MeSH Terms

Cardiomyopathies
Chest Pain
Echocardiography
Female
Heart Ventricles
Humans
Takotsubo Cardiomyopathy

Figure

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  Fig. 1 Electrocardiogram obtained during the emergency department visit. There is poor R progression in combination with T wave inversion in V1 and V2.

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  Fig. 2 Initial end-systolic (A) and end-diastolic (B) echocardiographic images obtained in the apical 4-chamber view. Initial end-systolic (C) and end-diastolic (D) computed tomographic images on 4-chamber view. Note isolated akinesia in the mid-portion of both the left and the right ventricles. The mid-portions of both the left and right ventricles exhibit akinesia. Movie files for transthoracic echocardiography and cine computed tomographic images may be requested from the corresponding author.

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  Fig. 3 Apical 4-chamber end-systolic (A) and end-diastolic (B) transthoracic echocardiographic images obtained after clinical recovery. LV systolic function was completely normalized, and there was no evidence of abnormal regional wall motion. LV: left ventricle.

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