Apical ballooning syndrome following exercise treadmill testing

Transient left ventricular apical ballooning syndrome is an increasingly recognized cause of acute coronary syndrome, particularly in postmenopausal women, and is the subject of increasing interest to both clinicians and researchers. Emotional and physical stressors are often implicated in its development and, while excess sympathetic drive appears to act as a primary trigger, the exact mechanism remains controversial. The clinical presentation is characterized by transient, often severe, left ventricular dysfunction affecting the mid and apical myocardium. By definition, no significant coronary artery lesions are present, although this may not be recognized at initial presentation. While recovery of function with evidence of limited myocardial necrosis is common, significant complications may manifest in the acute phase. A case involving an elderly patient who developed classical features of the syndrome following an exercise treadmill test is presented. To the authors' knowledge, the present case is the only such report that meets the recently proposed diagnostic criteria. The present case serves to highlight a rare but important complication of exercise testing in an elderly patient. Recent large systematic reviews have provided valuable insights into the clinical features of this condition. The current article examines the data from these studies and others to provide a comprehensive clinical overview.