Evidence of impaired coronary flow reserve and elevated microvascular resistances in a case of recurrent left apical ballooning.

A 56-year old man was admitted for precordial pain associated with dyspnea and evidence of myocardial ischemia on ECG and cardiac ultrasound. His previous history included an episode of left apical ballooning five years before. At angiography, no evidence of significant epicardial coronary artery disease was manifest. Interestingly, both coronary flow reserve and the index of microvascular resistances were abnormal, showing evidence of impaired microvascular function. This is the first report providing direct evidence of microvascular dysfunction in a patient with (recurrent) apical ballooning.