Use of Levosimendan for cardiogenic shock in patient with the apical ballooning syndrome.

Background: The apical ballooning syndrome (ABS), also known as takotsubo cardiomyopathy and the broken heart syndrome, is an acute cardiac syndrome frequently precipitated by a stressful event. It has a clinical presentation that is indistinguishable from myocardial infarction (1). Patients commonly present with chest pain and dyspnea or with cardiogenic shock (prevalence, 2.4% to 7.4%) and ventricular fibrillation (prevalence, 0.65% to 3.9%) (2). Treatment is nonspecific. Objective: To report a patient with ABS complicated by cardio- genic shock who recovered after intravenous administration of levo- simendan. Case Report: A 68-year-old woman with an unremarkable med- ical history was sent to the emergency department because of chest pain and worsening dyspnea. On arrival, she was intubated because of acute pulmonary edema and cardiogenic shock.Initial electrocardiography demonstrated sinus rhythm with significant ST-segment elevation in leads V3 to V5, and urgent coronary angiography demonstrated fully patent coronary arteries. Ventriculography, however, demonstrated classic ABS with anteroapical akinesis and basal hyperkinesis. Levosimendan infusion was started at a standard dose for bolus injection of 12g/kg per minute for 10 minutes followed by an infusion of 0.1g/kg per minute, with drastic improvement of clinical and hemodinamic status. Conclusion: Levosimendan seemed to lead to the recovery of our patient with ABS-induced cardiogenic shock. Further research is needed to determine whether it represents a safe treatment option for patients with the condition.