Background:
Apical ballooning syndrome (ABS) management has not been extensively studied. These patients are often managed as those with acute coronary syndrome. The objective of our study is to examine the role of medications like selective beta-blockers, statins, clopidogrel, and angiotensin converting (ACE) inhibitors post-discharge.
Methods:
From January, 2002 to December, 2007 18 consecutive patients were treated for ABS. Each patient was assessed by history, physical exam, electrocardiogram, laboratory investigations, telemetry, echocardiogram, coronary angiogram and later, by a follow up echo in 4-8 weeks.
Results:
All patients were female, the majority were caucasian and postmenopausal. The most common presentation was angina. Common EKG findings were T wave inversions, and prolonged QTc. Echocardiogram images demonstrated mid-ventricular and apical wall motion abnormalities and reduced ejection fraction, this was later confirmed by angiogram. All patients were alive at the time of discharge. Medications these patients received post discharge were selective beta-blockers 87.5 % (14/16), aspirin 100% (16/16), statins 62.5% (10/16), ACE inhibitors 81.2% ( 13/16), and clopidogrel 12.5% (2/16). After discharge from the hospital 31.2% (5/16) had recurrent chest pain on the above medical management. Recurrent chest pain developed in three out of five patients discharged on selective beta-blockers (p < 0.08, Fisher exact) and in three out of five patients who were discharged on statins (p < 0.65, Fisher exact). Patients who developed recurrent chest pain discharged on ACE inhibitors were four out of five (p<0.70, fisher exact test), and on clopidogrel were 0 out of five (p <0.45, fisher exact).
Conclusion:
Patients from our study have a higher rate of recurrent chest pain than previously reported. Chronic treatment with selective beta-blockers, ACE inhibitors, clopidogrel, and statins did not reduce the frequency of recurrent chest pain post-discharge. Although there is no evidence demonstrating a benefit, these patients are often treated as per guidelines for acute coronary syndrome. Our study demonstrates that ABS patients are subjected to ineffective treatment and there is an emergent need for management guidelines
Tako-Tsubo syndrome. Approach to the subject and Report of 2 cases
