Transiente linksventrikuläre apikale ballonierung, differentialdiagnose des akuten koronarsyndroms: "Broken heart of a priest"

We here report on a 64-year old patient with clinical signs of acute coronary syndrome, but without significant coronary artery disease, as assessed by angiography. However, there was a marked balloon-like, reversible left ventricular apical wall motion abnormality. This syndrome was initially recognized and reported in the Japanese population and was given the nick-name tako-tsubo-like left ventricular dysfunction, based on a round-bottomed narrow-necked Japanese fishing pot used for trapping octopus. The syndrome is characterized by transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of obstructive epicardial coronary disease. It more often affects postmenopausal women. Patients commonly present with chest pain, ST-segment elevation in the precordial leads, and relatively minor elevation of cardiac enzymes. An episode of emotional or physical stress frequently precedes presentation with the syndrome. The in-hospital mortality rate seems to be low, as does the risk for recurrence. However, the etiology and pathophysiological basis of tako-tsubo-like left ventricular dysfunction is a matter of debate.