A case of ultrashort‐acting beta‐blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction

Takama, Takuro; Fukue, Mitsunori; Sato, Hiroyuki; Taniuchi, Masato

doi:10.1002/jgf2.223

Cited by 3 publications

(4 citation statements)

References 11 publications

(21 reference statements)

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“…In terms of pharmacological treatment, the drugs commonly used for heart failure include ACE inhibitors, β-blockers and diuretics; these are cornerstones of the management of myocardial dysfunction in stress cardiomyopathy [ 83 ]. In particular, β-blockers have a role in reducing the extent of LVOT obstruction [ 84 ]. The rationale for their use can be understood in relation to the role that alpha and β-adrenergic stimulation has in the pathogenesis of stress cardiomyopathy; they exert their clinical effect by reducing the contractility at the base of the heart and by facilitating the diastolic filling of the left ventricle.…”

Section: Treatment and Postoperative Carementioning

confidence: 99%

Perioperative management of Takotsubo cardiomyopathy: an overview

Pillitteri,

Brogi,

Piagnani

et al. 2024

J Anesth Analg Crit Care

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Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.

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Section: Treatment and Postoperative Carementioning

confidence: 99%

Perioperative management of Takotsubo cardiomyopathy: an overview

Pillitteri,

Brogi,

Piagnani

et al. 2024

J Anesth Analg Crit Care

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“…On the other hand, precipitation of TTS by withdrawal of metoprolol in a patient has occurred [ 34 ], although that patient had LV outflow tract obstruction (LVOTO), where the β-blocker was indicated. Various cardioselective β 1 -blockers (e.g., metoprolol [ 35 ], bisoprolol, esmolol [short-acting] [ 21 , 36 ], landiolol [ultrashort-acting]) [ 37 , 38 , 39 ], non-cardioselective (propranolol) [ 40 , 41 ] or non-cardioselective β-blockers with associated α 1 -blocking effects (e.g., carvedilol or labetalol [ 40 ] have been used in patients with TTS, but no head-to-head comparisons of these drugs have been undertaken. There is also literature supporting the view that β-blockers are not beneficial in patients with TTS [ 42 ], as also shown by the reports revealing that a sizeable proportion of patients on a maintenance therapy with β-blockers have suffered TTS [ 43 ].…”

Section: Current Therapy Of Acute Ttsmentioning

confidence: 99%

“…Accordingly, it has been recently proposed that large doses of insulin infusions, in connection with careful monitoring to prevent hypoglycemia and hypokalemia, via concomitant infusions of dextrose and potassium supplementation, in conjunction with intravenous use of short-, or ultrashort-acting β-blockers (e.g., esmolol or landiolol) [ 39 ] ( Figure 7 ) perhaps have beneficial therapeutic effects in patients with TTS [ 10 , 11 ], addressing specifically the devastating metabolic impairment (glucose and lipid pathways dysregulation, leading to decreased final glycolytic and β-oxydation metabolites and reduced availability of Krebs intermediates), noted in TTS [ 117 , 118 ]. This proposal is based on previous literature of animal models of stress cardiomyopathy, recently summarized [ 10 ], and limited experience in patients with neurogenic cardiomyopathy and TTS [ 37 , 38 , 119 , 120 , 121 , 122 ] ( Figure 8 ). Consequently.…”

Section: Future Therapeutic Options For Ttsmentioning

confidence: 99%

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Takotsubo Cardiomyopathy: Current Treatment

Madias

2021

JCM

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Management of takotsubo syndrome (TTS) is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies. Although it has been emphasized that such non-specific therapies for TTS are consequent to its still elusive pathophysiology, one wonders whether it does not necessarily follow that the absence of knowledge of TTS’ pathophysiological underpinnings should prevent us for searching, designing, or even finding, therapies efficacious for its management. Additionally, it is conceivable that therapy for TTS may be in response to pathophysiological/pathoanatomic/pathohistological consequences (e.g., “myocardial stunning/reperfusion injury”), common to both TTS and coronary artery disease, or other cardiovascular disorders). The present review outlines the whole range of management principles of TTS during its acute phase and at follow-up, including considerations pertaining to the recurrence of TTS, and commences with the idea that occasionally management of TTS should consist of mere observation along the “first do no harm” principle, while self-healing is under way. Finally, some new therapeutic hypotheses (i.e., large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers) are being entertained, based on previous extensive animal work and limited application in patients with neurogenic cardiomyopathy and TTS.

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Recurrent takotsubo syndrome with worsening of left ventricular outflow obstruction during haemodialysis: a case report

Takada

Jujo

Ishida

et al. 2020

European Heart Journal - Case Reports

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Background The recurrence rate of takotsubo syndrome (TS) has been reported as 1.8% per patient-year while left ventricular outflow tract (LVOT) obstruction is comorbid in 10–25% of all instances of TS. The clinical course of recurrent TS with associated LVOT while on haemodialysis has rarely been reported. Case summary This case report involves a 60-year-old female patient receiving regular haemodialysis who was admitted for chest pain during ballroom dancing. Four years prior, she had suffered TS, and fully recovered after the hospitalization. An emergent coronary angiogram done during the second hospitalization showed no significant stenosis, and left ventriculography demonstrated mid-apical akinesia and basal hyperkinesia. Based on these findings, we diagnosed the recurrence of TS. Later in the admission, chest pain reappeared with the start of haemodialysis. A transthoracic echocardiogram demonstrated mean pressure gradient (PG) of LVOT was 58 mmHg, with systolic anterior motion of the mitral valve and basal-wall hyperkinesia. The main aetiology for her symptoms was considered as an exacerbation of LVOT obstruction due to removing intravascular volume by haemodialysis. After starting landiolol at 3 μg/kg/min, PG of LVOT and symptoms gradually improved with uptitration of landiolol. Finally, her chest pain resolved when mean PG of LVOT was down to 38 mmHg using 10 μg/kg/min of landiolol. Discussion To our knowledge, this is the first report of a recurrent TS case comorbid with LVOT obstruction while on regular haemodialysis. Landiolol, the ultrashort-acting beta-blocker, may be a promising therapeutic option for rapid recovery of increased PG due to LVOT obstruction.

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A case of ultrashort‐acting beta‐blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction

Cited by 3 publications

References 11 publications

Perioperative management of Takotsubo cardiomyopathy: an overview

Perioperative management of Takotsubo cardiomyopathy: an overview

Takotsubo Cardiomyopathy: Current Treatment

Recurrent takotsubo syndrome with worsening of left ventricular outflow obstruction during haemodialysis: a case report

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