A 57-year-old man was referred to our department with substernal chest pain. He was a smoker whose symptoms had started the day before, during an anxiety-associated conversation. At admission, the chest pain had almost disappeared. Serial electrocardiograms revealed a sinus rhythm associated with new inverted T waves, predominantly in the precordial leads ( Fig. 1 ). Troponin T was raised to 0.36 ng/mL at admission and decreased to 0.22 ng/mL the following day. A third myocardial blood test was normal.
At admission, coronary angiography showed normal epicardial coronary arteries; the left ventriculogram demonstrated midventricular dilation and akinesis with a hypercontractile apex and base in favour of a transient LV non-apical ballooning syndrome ( Fig. 2 , Panels A and B; Video 1 ). One day later, on cardiovascular MRI, steady-state free-precession three-chamber cine sequences ( Fig. 2 , Panels C and D; Video 2 ) confirmed WMAs involving the middle portions of the left ventricle but not the LV apex. However, long-axis dark-blood T2-weighted sequences detected apical and midventricular oedema ( Fig. 2 , Panel E). No abnormality was found on first-pass perfusion or delayed enhancement MRI ( Fig. 2 , Panel F). Surprisingly, segmental 2D longitudinal strain of the basal anterior and anterolateral segments was decreased significantly compared with the basal inferior and inferoseptal segments ( Figs. 3 and 4 ). A bull’s eye map of peak systolic strain showed abnormal contraction in the apex. WMAs assessed using MRI and 2D speckle-strain analysis reversed rapidly, returning to the normal range at two months.
