Transient pathologic Q waves in a case of apical ballooning

A 73-year-old woman with known mild systemic hypertension was admitted to our hospital because of a 2hour history of chest pain. As a remarkable fact, her husband had died that day. Physical examination showed a normal blood pressure (130/60 mm Hg) and a heart rate of 100 beats per minute. Hematologic values and serum creatinine levels were normal. Sodium and potassium serum levels were also within normal limits. Initial serum creatine kinase (CK) level was slightly increased (220 U/L; reference range, 24-170 U/L), with a troponin I level of 11.8 lg/mL (normal values up to 0.4 lg/mL). Chest x-ray was unremarkable. The first electrocardiogram (EKG) was performed when the patient still had chest pain and showed Q waves and ST elevation in all the precordial leads and leads I, II, and aVL (Fig. 1). Simultaneously, 2-dimensional echocardiography was carried out showing apical akinesis and mild ventricular dysfunction accompanied by ventricular dilatation. With the diagnosis of extensive acute anterior myocardial infarction (AMI), an urgent coronarography was undertaken to perform a primary angioplasty, but the coronary angiogram revealed a normal coronary tree. Left ventriculogram demonstrated extensive apical akinesis with hypercontractility of the basal segments (Fig. 2). An ejection fraction of 0.35 was calculated. Peak CK and troponin I serum levels were 2005 U/L and 31 lg/mL, respectively. An EKG performed 5 days later showed deep negative T waves in precordial leads, but Q waves could not be observed (Fig. 3). Three weeks after admission, a 2dimensional echocardiography showed normal ventricular function with no regional motion abnormalities. An almostnormal EKG was obtained with absence of Q waves and ST-T abnormalities (Fig. 4).