Cardiac magnetic resonance imaging (CMRI) takes on an important role in the diagnosis and follow-up of apical ballooning syndrome (takotsubo syndrome) a recently described cardiac condition characterised by transient dyskinesia of the left ventricle secondary to an acute emotional event. electrocardiogram (ECG) that may mimic acute myocardial infarction (MI) slightly increased myocardial enzymes Alvocidib in the absence of obstructive coronary artery disease. Our report highlights how cardiac magnetic resonance imaging (CMRI) can be a useful noninvasive tool and can potentially avoid cardiac catheterisation in an appropriate clinical setting. Case report A 53-year-old white woman with no prior cardiac problems presented to the emergency room (ER) with chest uneasiness and orthopnoea and was found to have ST elevation of >0.5 mm in leads V2-V6 on ECG (Figure 1) deep T inversions in V2-V6 and T inversions in inferior leads. The differential considerations included acute myocardial ischaemia acute dilatation of the left ventricle and myocardial contusion. Elevated troponin of 2.14 was noted. Figure 1 The electrocardiogram of the patient at the time of presentation shows sinus tachycardia and ST elevation Alvocidib in the precordial leads V2-V6 of >0.5 mm as well as wide spread T wave abnormalities. Cardiac catheterisation revealed normal coronary arteries. A LV angiogram recommended an unhealthy ejection small fraction with basal hypercontractility and apical akinesia. With these results it was regarded as that the individual got an anterior wall structure MI with spontaneous thrombolysis. An echocardiogram completed at the same time also demonstrated markedly reduced ejection small fraction Alvocidib of 10-15%. A cardiac MR research was purchased to eliminate MI and was performed utilizing a phased-array body matrix coil with shiny bloodstream cine (2 and 4 chamber and brief axis sights) and postponed improved (DE) sequences after gadolinium administration. Cardiac magnetic resonance imaging demonstrated poor ejection small fraction measuring <20% LV apical ballooning and normal contractility of the ventricular base (Figure 2). No abnormal myocardial enhancement was noted on the DE sequence (Figure 3). These findings were suggestive of apical ballooning syndrome and also explained the findings on cardiac catheterisation. Specific stressors on review of the patient's history included recent deaths of her husband and sister. Figure 2 Acute stage. (A) Cine True FISP imaging steady-state precession sequence in two chamber-during diastole and four chamber-during systole. (B) Show non-contractility Alvocidib and ballooning of the left ventricular apex. (C) Four chamber delayed postcontrast image ... Figure 3 Three months after the first scan. (A) Cine True fast imaging with steady-state precession sequence in the two chamber-diastolic and four chamber-systolic. (B) Shows normal contractility of the left ventricular apex with complete resolution of the apical ... The patient was managed as non-ischaemic cardiomyopathy in the hospital and was started Rabbit Polyclonal to CDC25C (phospho-Ser198). on angiotensin-converting enzyme inhibitors (ACEI) β-blockers and Lasix. At the time of discharge the patient’s vitals were stable. A follow-up CMRI 3 months later showed completely normal LV contractility as Alvocidib well as marked improvement of ejection fraction which increased from 20% to 70%. The LV apical ballooning also showed complete reversal (Figure 3). Based on the clinical presentation the diagnostic work up and the magnetic resonance imaging (MRI) findings the final diagnosis of apical ballooning syndrome was made. Discussion Takotsubo cardiomyopathy is a syndrome characterised by the acute onset of chest pain and a completely reversible regional contractile myocardial dysfunction. First described in the Japanese literature the apical ballooning was named after the bottle used for trapping octopus with a round bottom and a narrow neck.1 The characteristics needed for diagnosis include: (a) Transient akinesis or dyskinesis of the LV apex and midventricular segments with regional wall motion abnormalities extending beyond a single epicardial vascular distribution (b) Absence of significant obstructive coronary disease (c) New EKG abnormalities (either ST-segment elevation or T wave inversion) and (d) Absence of recent significant head trauma intracranial bleeding pheochromocytoma myocarditis and hypertrophic cardiomyopathy.2 Though the cause of this syndrome is unknown it is consistently observed after intense emotional or physical stress with strong predominance among postmenopausal women. During the course of the acute phase complications like.