ObjectiveTo improve our knowledge on the clinical characteristics, diagnosis, and treatment of apical ballooning syndrome (ABS) complicated with asthma. Methods and resultsA 73 year-old female patient, with a 10-year history of asthma and a 4-year history of recurrent chest distress, was admitted due to chest distress, cough for 15 days and chest pain for 7 hours.Coronary arteriography during emergent percutaneous coronary intervention (PCI) showed a 40% stenosis in the anterior descending artery, and stenosis was not found in other vessels.Left ventriculographic showed apical ballooning, echocardiography showed a 35% left ventricular ejection fraction, and the patient was diagnosed as having ABS with asthma. The cardiac function gradually recovered after symptom-targeted treatment. Literatures showed that it was difficult to distinguish between ABS and acute myocardial infarction; the treatments and prognoses of them were very different. When acute left ventricular failure was complicated with ABS and asthma, it was difficult to distinguish from pulmonary asthma and the treatment was very different. ConclusionClinicians should improve the knowledge of ABS and put more emphasis on differential diagnosis so as to make the right treatment decision.