Dynamic left ventricular outflow tract obstruction induced by dobutamine stress echocardiography leading to myocardial ischemia and infarction

Makaryus, Amgad N.; Meraj, Perwaiz; Rosman, David

doi:10.1007/s10554-006-9102-y

Cited by 9 publications

(2 citation statements)

References 18 publications

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“…Indeed, such models could additionally explore whether LVOTO or MCO precede or follow the emergence of TTS, since ~20% of patients with DSE show such changes, something still remaining unresolved heretofore [50]. The majority of patients with transient ECHO changes do not developed TTS in the setting of stress ECHO or DSE, and do not have history of prior TTS; however, DSE-triggered LVOTO has led to AMI in a 70-year-old woman [64]. The chronicity of chest pain in patients with pseudopositive DSE reminds one the alleged persisting chest pain in patients who have previously suffered TTS.…”

Section: Echo Manifestations In Patients Undergoing Dsementioning

confidence: 99%

Dobutamine stress echocardiography in the exploration of the pathophysiology of takotsubo syndrome

Madias¹

2019

Long-Term Survival of Patients With Ischemic Cardiomyopathy and Diabetes as Compared to Those Without Diabetes Undergoing Myoca

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The pathophysiology underlying takotsubo syndrome (TTS) remains elusive. TTS is triggered by emotional/physical stresses, administered catecholamines/sympathomimetics, and during dobutamine (DB) stress echocardiogram (ECHO) testing (DSE). DSE induces dynamic left ventricular outflow tract obstruction (LVOTO) and mid-cavitary obstruction (MCO), particularly in postmenopausal women with chest pain and normal coronaries. Some patients suffer TTS, or quasi/atypical TTS, with the vast majority recovering shortly after DSE, although troponins and serial ECHO with/without strain/strain rate ECHO have not been employed to evaluate whether a few of such patients have not developed a forme fruste TTS. This piece proposes that retrospective/prospective scrutiny of ECHOs may provide valuable insights about the pathophysiology of TTS. For cases of DSE-triggered TTS, the regional hyperdynamic myocardial responses (RHMR) to DB, which preceded the regional myocardial contraction abnormalities (RMCAs), LVOTO, MCO and mitral regurgitation (MR) of TTS, should be evaluated. The temporal relationship of RHMR to DB and LVOTO/ MCO/MR, in patients who did/did not suffer TTS should be studied. Evaluation of RHMR to DB in patients with normal DSE may also be contributory. Additionally, patients with positive DSE due to coronary artery disease with an associated TTS-like component (mixed phenotypes) should be scrutinized. ECHOs should be correlated with symptoms during DSE, dose of DB, age, gender, history of hypertension and chest pain, blood pressure and heart rate changes during testing, presence of septal hypertrophy and sigmoid septum in the baseline ECHO, response of chest pain and RHMR and other ECHO abnormalities to β-blockers, follow-up morbidity, and recurrence of TTS. "the search of truth always must trump hubris, bias, complacency, and the fear of new knowledge." Lee Goldman Pathophysiology insights of enigmatic diseases [e.g., takotsubo syndrome (TTS)] should be sought in every conceivable source (i.e., symptom/sign/comorbidity/laboratory test) that appear(s) to provide even an inkling that a cause and effect association may be at work.

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Section: Echo Manifestations In Patients Undergoing Dsementioning

confidence: 99%

Dobutamine stress echocardiography in the exploration of the pathophysiology of takotsubo syndrome

Madias¹

2019

Long-Term Survival of Patients With Ischemic Cardiomyopathy and Diabetes as Compared to Those Without Diabetes Undergoing Myoca

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“…The pathogenesis of the dynamic gradient that may be detected in TS could be due to a geometric susceptibility of the heart – a sigmoid or bulging interventricular septum, a small LV [35,153–155], or abnormal mitro-aortic and septo-aortic angles [156]. Elderly women have a greater tendency to develop hypertrophy of the basal anterior septum.…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Takotsubo cardiomyopathy – a clinical review

2011

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SummaryStress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.

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Dobutamine

2016

Meyler's Side Effects of Drugs

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Dynamic left ventricular outflow tract obstruction induced by dobutamine stress echocardiography leading to myocardial ischemia and infarction

Cited by 9 publications

References 18 publications

Dobutamine stress echocardiography in the exploration of the pathophysiology of takotsubo syndrome

Dobutamine stress echocardiography in the exploration of the pathophysiology of takotsubo syndrome

Takotsubo cardiomyopathy – a clinical review

Dobutamine

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