Apical ballooning syndrome

A 32-year-old woman walking in a street suddenly receives a call saying that her father died in a car accident. The woman developed shortness of breath, pain in her left arm, and slowly developed chest pain. After taking to the hospital, the doctor confirmed it as “Broken heart syndrome”. You might have heard about such situations in your daily life. Have you ever wondered what exactly it is and how an acutely stressful situation can impact cardiac physiology? If so, the article provides you detailed information regarding this.

Apical ballooning syndrome (ABS), also called as Broken heart syndrome or stress-induced cardiomyopathy or Takotsubo cardiomyopathy or Takotsubo syndrome is a temporary condition where your heart muscle suddenly becomes weakened or “stunned”. This is due to stressful situations like the sudden death of a loved one, being diagnosed with a dreadful disease, surprise parties, etc. Women are more likely than men to experience this sudden, intense chest pain and may occur even if you are healthy. Good news is that the condition is usually treatable, and the bad news is it may lead to severe short-term heart muscle failure.

The main symptoms of apical heart syndrome are chest pain and shortness of breath, similar to heart attack. That is the reason people get confused with ABS as a heart attack. In severe conditions, you may have an irregular heartbeat, sudden cardiac arrest. Nearly 10% of people develop signs and symptoms of cardiogenic shock such as hypotension, abnormal mental status, and cold extremities.

Several factors that can help distinguish ABS from other cardiac conditions.

ABSOther heart conditions
It often occurs when there is a stressful condition. It can occur anytime.
It is a self-limiting syndrome. It can be managed only with thorough treatment options.
There will be a reduction in blood flow but no blockage of the artery. It is caused by complete blockage of the heart artery.
Test reports show ballooning and unusual movement of the lower left chamber of the heart. Test reports show a blockage in the coronary arteries or damage, depending on the condition.

The exact cause of ABS is still not known. But increased stress hormones like adrenaline temporarily damage the hearts of some people. Narrowing of the small and large arteries of the heart also plays a major role.

Some of the emotional conditions that trigger the ABS are:

  • News of an unexpected death of a loved one
  • Natural disasters
  • Having to perform publicly
  • Car accident or major surgery
  • Major loss in business

Some medications such as epinephrine, duloxetine, venlafaxine, and levothyroxine also contribute to ABS.

In most of the cases, ABS recovers quickly and don’t have any long-lasting effects. But there are chances that you may have ABS again if you have another stressful experience. There are few complications such as:

  • Pulmonary edema-back up of fluids into lungs
  • Hypotension-low blood pressure
  • Irregular heart beat

To diagnose the syndrome, your doctor will first ask you about your health history and perform a physical exam. The following tests are recommended to confirm the diagnosis.

Electrocardiogram (ECG)

In this test, wires are placed on the chest that records the electrical impulses that make your heart beat. An ECG records these electrical signals that help your doctor to determine any irregularities in the heart rhythm and structure.

Chest X-ray

Chest X-ray is recommended mainly to see if the heart is enlarged or has an irregular shape, or to check any problems in your lungs that are causing the symptoms.


This test includes an ultrasound of your chest, detailed images of your heart’s structure and function. The ultrasound waves are transmitted, and their echoes are recorded with a transducer held outside your body. The information from the transducer is then used (by a computer) to create moving images on a video monitor.

Blood tests

Certain enzymes in the blood increase in people with ABS. To detect this, your doctor suggests for a blood test.

Coronary angiogram

This test can know the blockage in the blood vessels if any. In this test, a type of dye is injected to make the blood vessels of your heart more visible. Then, an X-ray machine takes a series of images that gives detailed look of blood vessels.

There is no specific treatment for ABS. But the treatment is similar to heart attack until the diagnosis is clear. Once the cause is clear, your doctor may recommend heart medication so that your heart does not have to work as hard as usual while you recover and to prevent further attacks. The commonly prescribed drugs are angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and diuretics and drugs such as aspirin are prescribed in early stages to reduce pain. You will recover fully within one to two months.

If the symptoms are not controlled with medications, doctors suggest for surgical techniques like balloon angioplasty and stent replacement for Takotsubo cardiomyopathy treatment. These surgical techniques treat blocked arteries.

ABS can occur again in your life, and hence managing stress in your life is very crucial to prevent recurrence.