Dynamic Left Ventricular Outflow Tract Obstruction: A Potential Complication of Takotsubo Cardiomyopathy

Abstract

Takotsubo cardiomyopathy is characterized by a clinical presentation similar to those of acute coronary syndrome and nonobstructive coronary arteries. This syndrome is triggered by physical or mental stress and is sometimes accompanied by left ventricular outflow tract (LVOT) obstruction. Takotsubo cardiomyopathy is caused by a hyperdynamic basal portion of the left ventricle. Detecting LVOT obstruction is important to initiate targeted treatment. Beta blockers and fluid resuscitation are the primary therapies used to decrease the LVOT gradient. Inotropic agents and nitrates should be avoided to prevent increasing the level of LVOT obstruction. Clinicians should keep dynamic LVOT obstruction in mind when evaluating patients with Takotsubo syndrome. Transthoracic echocardiography is an essential and practical method to diagnose this complication.

Keywords

• Apical ballooning
• left ventricular outflow tract obstruction
• Takotsubo syndrome

Dinamik Sol Ventrikül Çıkış Yolu Obstrüksiyonu: Takotsubo Kardiyomiyopatisinin Potansiyel Komplikasyonu

Abstract

Takotsubo kardiyomiyopatisi, akut koroner sendroma benzer klinik tablo ve obstrüktif olmayan koroner arterler ile karakterizedir. Bu sendrom fiziksel ya da zihinsel stres tarafından tetiklenir. Sol ventrikül çıkış yolu (LVOT) obstrüksiyonu bazen Takotsubo sendromuna eşlik eder. Bu fenomene sol ventrikülün hiperdinamik bazal kısmı neden olur. LVOT obstrüksiyonunu tespit etmek, hedefe yönelik tedaviyi başlatmak için önemlidir. Beta-blokerler ve sıvı resüsitasyonu LVOT gradyanını azaltan ana tedavi yöntemidir. LVOT obstrüksiyonunun artmasını önlemek için inotropik ajanlardan ve nitratlardan kaçınılmalıdır. Klinisyenler, Takotsubo sendromu hastalarını değerlendirirken dinamik LVOT obstrüksiyonunu akılda tutmalıdır. Transtorasik ekokardiyografi bu komplikasyonu teşhis etmek için temel ve pratik bir araçtır.

Keywords

• Apikal balonlaşma
• sol ventrikül çıkış yolu obstrüksiyonu

References

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