Atypical acute myocardial ischemia syndrome with reversible left ventricular (LV) wall motion abnormalities ("apical ballooning") without significant coronary artery disease

We report on three patients with acute myocardial ischemia syndrome, without significant coronary artery disease, who were admitted within one year in our hospital and presenting an atypical balloon-like, reversible left ventricular apical wall motion abnormality. The reported cases showed the following similarities: 1) elderly women (age > 65 years), 2) triggered by physical or emotional stress, 3) dynamic reversible ST-T segment abnormalities and 4) positive troponin I. During a one-year follow-up, all patients remained asymptomatic. As compared to the usual forms of the acute coronary ischemia syndrome, this syndrome showed a unique balloon-like left ventricular (LV) wall motion abnormality at the apex, which did not correlate with the coronary supply of a major coronary vessel. The etiology and pathophysiological. basis of this coronary syndrome, which has previously been described in Japan, is still not well understood.