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

Year 2020, Volume: 23 Issue: 1, 73 - 75, 01.04.2020

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.

References

  • 1. Ishihara M. Takotsubo cardiomyopathy and left ventricular outflow tract obstruction. Circ J 2015;79(4):758-60.
  • 2. Fuensalida A, Cortes M, Gabrielli L, Mendez M, Martinez A, Martinez G. Takotsubo syndrome-different presentations for a single disease: A case report and review of literature. World J Cardiol 2018;10(10):187-90.
  • 3. Ozaki K, Okubo T, Tanaka K, Hosaka Y, Tsuchida K, Takahashi K, et al. Manifestation of latent left ventricular outflow tract obstruction in the acute phase of Takotsubo cardiomyopathy. Intern Med 2016;55(23):3413-20.
  • 4. Kawaji T, Shiomi H, Morimoto T, Tazaki J, Imai M, Saito N, et al. Clinical impact of left ventricular outflow tract obstruction in Takotsubo cardiomyopathy. Circ J 2015;79(4):839-46.
  • 5. Santoro F, Ieva R, Ferraretti A, Fanelli M, Musaico F, Tarantino N, et al. Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: results from a multicenter registry. Cardiovasc Ther 2016;34(3):161-6.

Dinamik Sol Ventrikül Çıkış Yolu Obstrüksiyonu: Takotsubo Kardiyomiyopatisinin Potansiyel Komplikasyonu

Year 2020, Volume: 23 Issue: 1, 73 - 75, 01.04.2020

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.

References

  • 1. Ishihara M. Takotsubo cardiomyopathy and left ventricular outflow tract obstruction. Circ J 2015;79(4):758-60.
  • 2. Fuensalida A, Cortes M, Gabrielli L, Mendez M, Martinez A, Martinez G. Takotsubo syndrome-different presentations for a single disease: A case report and review of literature. World J Cardiol 2018;10(10):187-90.
  • 3. Ozaki K, Okubo T, Tanaka K, Hosaka Y, Tsuchida K, Takahashi K, et al. Manifestation of latent left ventricular outflow tract obstruction in the acute phase of Takotsubo cardiomyopathy. Intern Med 2016;55(23):3413-20.
  • 4. Kawaji T, Shiomi H, Morimoto T, Tazaki J, Imai M, Saito N, et al. Clinical impact of left ventricular outflow tract obstruction in Takotsubo cardiomyopathy. Circ J 2015;79(4):839-46.
  • 5. Santoro F, Ieva R, Ferraretti A, Fanelli M, Musaico F, Tarantino N, et al. Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: results from a multicenter registry. Cardiovasc Ther 2016;34(3):161-6.
There are 5 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Reports
Authors

Özgür Akbal This is me 0000-0002-3882-0288

Berhan Keskin This is me 0000-0002-5879-2245

Ahmet Karaduman This is me 0000-0003-4096-486X

Seda Tanyeri This is me 0000-0002-0933-9233

Ali Karagöz This is me 0000-0002-0438-2021

Publication Date April 1, 2020
Published in Issue Year 2020 Volume: 23 Issue: 1

Cite

Vancouver Akbal Ö, Keskin B, Karaduman A, Tanyeri S, Karagöz A. Dynamic Left Ventricular Outflow Tract Obstruction: A Potential Complication of Takotsubo Cardiomyopathy. Koşuyolu Heart Journal. 2020;23(1):73-5.