Key result
Medical management resulted in symptom resolution and normalization of left and right ventricular ejection fraction and wall motion by day 7 in a patient with biventricular apical ballooning.
Case Report (n=1)
This case report demonstrates a rare presentation of biventricular apical ballooning that rapidly resolved with medical management.
Suggests potential for rapid recovery with medical management in biventricular apical ballooning; hypothesis-generating from single case report.
A 65-year-old lady with hypertension and COPD presented with acute onset shortness of breath, diaphoresis and nausea without chest pain. She was tachycardic and volume overloaded on examination. ECG showed biatrial enlargement with non-specific ST-T changes. D-Dimer, troponin and BNP were elevated. Echocardiogram revealed ejection fraction (EF) <25%, left ventricle (LV) apical ballooning, dyskinetic apex with ballooning of the right ventricle (RV) and elevated RV pressure of 50–60 mmHg. Patient had a left and right coronary angiogram that showed mild non-obstructive coronary artery disease and mild pulmonary hypertension with elevated wedge pressure. Symptoms resolved with medical management and repeat echocardiogram in 3 days showed improved LV EF of 45% and cardiac MRI on day 7 showed normal EF and normal LV and RV wall motion with no evidence of myocarditis.
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Aruni et al. (2013) conducted a case report in Biventricular apical ballooning (n=1). Medical management was evaluated on Resolution of symptoms and normalization of ejection fraction and wall motion. Medical management resulted in symptom resolution and normalization of left and right ventricular ejection fraction and wall motion by day 7 in a patient with biventricular apical ballooning.
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