Letter to the Editor Transient impairment of myocardial perfusion in a patient with apical ballooning syndrome

Wedescribeacaseofa76-year-oldwomanwhopresentedwithchestpainafteraviolentargument.Onadmissiontheelectrocardiogramshowed 1-mm ST segment elevation in II, III, aVF, V3–V6 leads; the subsequent electrocardiogram showed T-wave inversion in the same leads. Peak troponin I level was 7.3 ng/dl (normal b0.4 ng/dl). Emergency angiography demonstrated the so-called “apical ballooning”, in the absence of any obstructive coronary artery disease. A myocardial contrast echocardiogram performed 5 days later showed a large perfusion defect in the akinetic apical region of the left ventricle; at 1-month follow-up myocardial perfusion and left ventricular wall motion became completely normal. In patients with apical ballooning syndrome a catecholamine-mediated endothelial injury might be responsible of a microvascular coronary dysfunction which causes myocardial ischemia and subsequent myocardial stunning. © 2007 Elsevier Ireland Ltd. All rights reserved.