Int J Angiol 2007; 16(2): 62
DOI: 10.1055/s-0031-1278250
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Reversible left ventricular apical ballooning associated with jet lag in a Taiwanese woman: A case report

Nen-Chung Chang1 2 , Mei-Shu Lin3 , Chun-Yao Huang1 2 4 5 , Chun-Ming Shih1 2 , Wei-Fung Bi1 2
  • 1Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital;
  • 2Department of Internal Medicine, Taipei Medical University;
  • 3Department of Pharmacy, National Taiwan University Hospital;
  • 4Department of General Medicine, Taipei Medical University;
  • 5Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
Further Information

Publication History

Publication Date:
27 April 2011 (online)


Reversible left ventricular apical ballooning, without coronary artery stenosis, is a novel heart syndrome mimicking acute myocardial infarction, and is very rare in Taiwan. A 74-year-old Taiwanese woman returned from travelling abroad for one week and suffered from persistent, severe jet lag with sleep disturbance. She had a cold exacerbated by bronchial asthma for three days. She presented with sudden onset of chest pain after drinking three cups of coffee and taking a sauna for more than 1 h. On admission, an electrocardiogram showed ST segment elevation in leads II, III, aVF and V3^, and cardiac enzyme tests revealed minimal elevation. An echocardiogram showed apical ballooning and basal hyperkinesias of the left ventricle (LV) in systole. A coronary angiogram on the second day was normal, while the ST segment was still elevated, and the patient continued to experience chest pain. A negative T wave developed three days later. The electrocardiogram abnormality and LV dysfunction resolved completely six months later. A takotsubo (ampulla) cardiomyopathy was diagnosed. The activated myocardial adrenergic nervous system, stimulated by acute and marked stress in this patient, with more adrenergic innervations distributed in the apex of the LV, may be the trigger for this novel cardiac syndrome.