Two cases of apical ballooning syndrome masking apical hypertrophic cardiomyopathy

Tex Heart Inst J. 2014 Apr 1;41(2):179-83. doi: 10.14503/THIJ-13-3191. eCollection 2014 Apr.

Abstract

Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy is seen in apical-variant hypertrophic cardiomyopathy. We report the cases of 2 patients who presented with takotsubo cardiomyopathy and were subsequently found to have apical-variant hypertrophic cardiomyopathy, after the apical ballooning from the takotsubo cardiomyopathy had resolved. The first patient, a 43-year-old woman with a history of alcohol abuse, presented with shortness of breath, electrocardiographic and echocardiographic features consistent with takotsubo cardiomyopathy, and no significant coronary artery disease. An echocardiogram 2 weeks later revealed a normal left ventricular ejection fraction and newly apparent apical hypertrophy. The 2nd patient, a 70-year-old woman with pancreatitis, presented with chest pain, apical akinesis, and a left ventricular ejection fraction of 0.39, consistent with takotsubo cardiomyopathy. One month later, her left ventricular ejection fraction was normal; however, hypertrophy of the left ventricular apex was newly noted. To our knowledge, these are the first reported cases in which apical-variant hypertrophic cardiomyopathy was masked by apical ballooning from stress-induced cardiomyopathy.

Keywords: Cardiomyopathy, hypertrophic/complications/diagnosis; heart ventricles/physiopathology; takotsubo cardiomyopathy/diagnosis/physiopathology; time factors; ventricular dysfunction, left.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adult
  • Aged
  • Alcoholism / complications
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
  • Cardiomyopathy, Hypertrophic* / diagnosis
  • Cardiomyopathy, Hypertrophic* / drug therapy
  • Cardiomyopathy, Hypertrophic* / etiology
  • Cardiomyopathy, Hypertrophic* / physiopathology
  • Diagnosis, Differential
  • Echocardiography / methods
  • Female
  • Humans
  • Pancreatitis / complications
  • Stroke Volume
  • Takotsubo Cardiomyopathy / diagnosis*
  • Treatment Outcome
  • Ventricular Function, Left

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors