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VOLUME 15 , ISSUE 1 ( January, 2011 ) > List of Articles


Apical ballooning syndrome after attempted suicidal hanging

Gagan Brar, Ramanathan Moorthy

Keywords : Apical ballooing, left ventricular dysfunction, suicidal hanging

Citation Information : Brar G, Moorthy R. Apical ballooning syndrome after attempted suicidal hanging. Indian J Crit Care Med 2011; 15 (1):43-45.

DOI: 10.4103/0972-5229.78225

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2011; The Author(s).


We report a case of “Apical Ballooning Syndrome” following attempted suicidal hanging. Our patient developed retrosternal chest pain and ischemic changes on electrocardiography (ECG), a day after the suicidal attempt. She underwent an angiogram considering the possibility of acute coronary syndrome. However, her coronary arteries were normal; the left ventricle showed the typical ballooning pattern characterized by hypokinesia of the distal septum and apex. On follow-up a week later, she remained asymptomatic; her ECG changes had reversed and the left ventricular contractility was normal on echocardiography.

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  1. Sato H, Tateishi H, Uchida T, Dote K, Ishihara M. Tako-Tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K, Haze K, Hori M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyoronsha Publishing Company; 1990. p. 56-64.
  2. Pollick C, Cujec B, Parker S, Tator C. Left ventricular wall motion abnormalities in subarachnoid hemorrhage: An echocardiographic study. J Am Coll Cardiol 1988;12:600-5.
  3. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. Eur Heart J 2006;27:1523-9.
  4. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539-48.
  5. Ako J, Sudhir K, Farouque HM, Honda Y, Fitzgerald PJ. Transient left ventricular dysfunction under severe stress: Brain-heart relationship revisited. Am J Med 2006;119:10-7.
  6. Mori H, Ishikawa S, Kojima S, Hayashi J, Watanabe Y, Hoffman JI, et al. Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovasc Res 1993;27:192-8.
  7. Ito K, Sugihara H, Katoh S, Azuma A, Nakagawa M. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT-comparison with acute coronary syndrome. Ann Nucl Med 2003;17:115-22.
  8. Mohammedi I, Perret X, Argaud L, Le Vavasseur O, Martin O, Robert D. Hanging causing severe reversible left ventricular dysfunction. Intensive Care Med 2005;31:495.
  9. Gnanavelu G, Sathiakumar DBD. Reversible left ventricular dysfunction in suicidal hanging. J Assoc Physicians India 2008;56:545-6.
  10. Valletta ME, Haque I, Al-Mousily F, Udassi J, Saidi A. Hanging causing severe reversible left ventricular dysfunction. Pediatr Crit Care Med 2008;9:47-50.
  11. Sivanandan S, Sinha A, Juneja R, Lodha R. Reversible acute left ventricular dysfunction in accidental strangulation. Pediatr Crit Care Med 2009;10:5-8.
  12. Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart 2003;89:1027-31.
  13. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J 2008;155:408-17.
  14. Sarda L, Colin P, Boccara F, Daou D, Lebtahi R, Faraggi M, et al. Myocarditis in patients with clinical presentation of acute myocardial infarction and normal coronary angiograms. J Am Coll Cardiol 2001;37:786-92.
  15. Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002;143:448-55.
  16. Trujillo MH, Fragachan CF, Tortoledo F. Noncardiogenic pulmonary edema following accidental near-hanging. Heart Lung 2007;36:364-6.
  17. Sauvageau A, Racette S. Agonal sequences in a filmed suicidal hangings: Analysis of respiratory and movement responses to asphyxia by hanging. J Forensic Sci 2007;52:957-9.
  18. Kyuma M, Tsuchihashi K, Shinshi Y, Hase M, Nakata T, Ooiwa H, et al. Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. Circ J 2002;66:1181-4.
  19. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Int Med 2004;141:858-65.
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