Norepinephrine-associated left ventricular outflow tract obstruction and systolic anterior movement

Mampuya, Warner; Dumont, Jonathan; Lamontagne, François

doi:10.1136/bcr-2018-225879

Cited by 4 publications

(2 citation statements)

References 8 publications

(8 reference statements)

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“…This is because, in addition to the positive inotropic activity, it possesses vasoconstrictive activity on both the arterial and venous districts, increasing, in this way, the preload and afterload. However, cases of precipitated LVOTO after administration of noradrenaline to counteract vasoplegia have been reported [ 90 ]. As already illustrated, volume filling also plays a role in the mechanisms that lead to LVOTO.…”

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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“…Thus, logically, catecholamines are described as a potential inducer of LVOTO. This has mostly been described with inotropes such as dobutamine but also with dopamine and norepinephrine [ 20 - 25 ].…”

Section: Pathophysiology Of Left Ventricular Outflow Tract Obstructionmentioning

confidence: 99%

Left Ventricular Outflow Tract Obstruction in Patients Treated With Milrinone for Cerebral Vasospasm: Case Report and Literature Review

Baulier¹,

Lessert²,

Chauvet³

et al. 2022

JMIRx Med

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Subarachnoid hemorrhage is associated with high morbidity and mortality, and cerebral arterial vasospasm is one of its main complications that determines neurological prognosis. The use of intravenous milrinone is becoming more common in the treatment of vasospasm. This molecule has positive inotropic and vasodilating properties by inhibiting phosphodiesterase-3. Its most described side effects are cardiac arrhythmias and arterial hypotension. In this paper, we raise a new issue concerning milrinone and discuss an undescribed side effect of this treatment, left ventricular outflow tract obstruction (LVOTO). Dynamic LVOTO is a clinical situation favored by hypovolemia, decreased left ventricular afterload, and excessive inotropism that can lead to severe hemodynamic failure and pulmonary edema. To our knowledge, this is the first study describing milrinone-induced LVOTO. This could compromise cerebral perfusion and therefore the neurological prognosis of patients. While it is known that catecholamines may induce LVOTO, milrinone-induced LVOTO appears to be a new pathophysiological entity of which neurosurgical intensivists should be aware.

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Norepinephrine

2020

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Norepinephrine-associated left ventricular outflow tract obstruction and systolic anterior movement

Cited by 4 publications

References 8 publications

Perioperative management of Takotsubo cardiomyopathy: an overview

Perioperative management of Takotsubo cardiomyopathy: an overview

Left Ventricular Outflow Tract Obstruction in Patients Treated With Milrinone for Cerebral Vasospasm: Case Report and Literature Review

Norepinephrine

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