Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Classically, left ventricular apical "balloon" dilation and dysfunction with preserved basal wall motion on cardiac imaging Emotional and/or physical stress frequently preceding symptoms of chest discomfort and/or dyspnea No consensus diagnostic criteria Catecholamine-stimulated myocardial stunning and evidence of inflammation on acute imaging No significant stenosis on coronary angiography, and the regional wall motion abnormalities extend beyond a single coronary artery distribution +++ GENERAL CONSIDERATIONS ++ Transient left ventricular apical ballooning named for shape of Japanese octopus fishing pot Mechanism unknown but probably related to sympathetic activation and catecholamine release Probably shares a similar mechanism to "neurogenic stunned myocardium" described after subarachnoid hemorrhage and stroke +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Typically women over age 50 years Chest discomfort and/or dyspnea frequently following emotional or physical stress Syncope Ventricular fibrillation cardiac arrest +++ PHYSICAL EXAM FINDINGS ++ Tachypnea Tachycardia Hypertension or hypotension Cardiogenic shock Elevated jugular venous pressure Pulmonary rales Prominent, diffuse, and sustained apical impulse Gallop rhythms may be present Edema +++ DIFFERENTIAL DIAGNOSIS ++ Acute myocardial infarction Myocarditis Cardiomyopathy following subarachnoid hemorrhage +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Cardiac enzymes may be normal or mildly elevated Serum brain natriuretic peptide levels are elevated +++ ELECTROCARDIOGRAPHY ++ Sinus tachycardia Prolonged PR interval in one-quarter Prolonged QT interval in one-quarter ST-segment elevations in the anterior precordial leads in 15–20% Q waves in the anterior precordial leads in > one-third Diffuse, deep T-wave inversions develop within 48 hours +++ IMAGING STUDIES ++ Chest x-ray: – Cardiac silhouette may be normal or enlarged – Pulmonary vascular congestion or edema may be present Echocardiography: Classically, pattern of apical "balloon" dilation with akinesis or dyskinesis and preserved contractility of the basilar segments. Other patterns of akinesis include midventricular and basal or inverted variant New data showing myocardial edema visualization on cardiac MRI +++ DIAGNOSTIC PROCEDURES ++ Cardiac catheterization: – No angiographically significant epicardial coronary artery disease or spasm – Left ventriculography reveals apical akinesis or dyskinesis – Elevated left ventricular end diastolic pressure – Right heart catheterization demonstrates variable elevations in pulmonary capillary wedge pressure, pulmonary artery pressure, right atrial pressure, and reduced cardiac output +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ All patients +++ HOSPITALIZATION CRITERIA ++ Suspected acute coronary syndrome Congestive heart failure Syncope Arrhythmias +++ MEDICATIONS ++ Supportive therapy including diuretics and vasodilators Pressors and beta agonists are typically avoided in favor of mechanical support when needed Chronic heart failure medications for persistent left ventricular ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth