Recognition of the apical ballooning syndrome in the United

Acute dilated cardiomyopathy is an uncommon butoften life-threatening cardiovascular event. Despitevaried clinical presentations that may include cardio-genic shock, ventricular tachyarrhythmias, and chest pain mimicking acute myocardial infarction, a growing list of potentially reversible pathogeneses should be considered in the initial differential diagnosis. These may include cardio-toxins, such as excessive alcohol, cocaine, or antiretroviral agents; nutritional deficiencies (eg, thiamine, selenium, car-nitine); endocrine disturbances (hyperthyroidism, hypothy-roidism, pheochromocytoma); viral myocarditis; Lyme car-ditis; hypersensitivity reactions; infiltrative processes, such as hemochromatosis; peripartum disease; and tachycardia-induced cardiomyopathy.1 Recently, a newly described left ventricular apical ballooning syndrome has been added to the growing list of diagnostic possibilities.2 See p 47