Tako-tsubo-like left ventricular dysfunction It is not very often that a novel cardiac syndrome provokes such a great interest from cardiologists worldwide. In 1991, cardiologists from Hiroshima, Japan were the first to report a cardiac syndrome with female preponderance exhibiting transient left ventricular apical ballooning,electrocardiographic changes, and minimal myocardial enzymatic release mimicking acute myocardial infarction without significant epicardial coronary artery disease.The cardiologists from the Hiroshima City Hospital originally proposed the term
tako-tsubo-like left ventricular dysfunction, because the typical shape on end-systolic left ventriculogram resembles a tako-tsubo (octopus trap) with a round (akinetic) apex and narrow (hyperkinetic) base. Based on the first series of 30 patients from this group, published ten years later, they believed that simultaneous multivessel coronary spasm was one of the main causes.Of note, in their series of 30 patients acute
coronary angiography revealed no coronary artery disease in 25 patients, and only moderate single coronary artery disease in five patients. Three patients showed
spontaneous multivessel coronary spasm. In tenpatients, coronary spasm could be provoked by either ergonovine or acetylcholine.Vasospastic ischaemia is supposed to be more common in Japan than in the rest of the world.