Recognition of the Apical Ballooning Syndrome in the United States

Acute dilated cardiomyopathy is an uncommon but often life-threatening cardiovascular event. Despite varied clinical presentations that may include cardiogenic shock, ventricular tachyarrhythmias, and chest pain mimicking acute myocardial infarction, a growing list of potentially reversible pathogeneses should be considered in the initial differential diagnosis. These may include cardiotoxins, such as excessive alcohol, cocaine, or antiretroviral agents; nutritional deficiencies (eg, thiamine, selenium, carnitine); endocrine disturbances (hyperthyroidism, hypothyroidism, pheochromocytoma); viral myocarditis; Lyme carditis; hypersensitivity reactions; infiltrative processes, such as hemochromatosis; peripartum disease; and tachycardiainduced cardiomyopathy.1 Recently, a newly described left ventricular apical ballooning syndrome has been added to the growing list of diagnostic possibilities.2