Successful use of the impella ventricular assist device for management of reverse Takotsubo Cardiomyopathy in the setting of acute intracranial hemorrhage

Barsoum, Emad; Elhosseiny, Sherif; Patel, Brijesh; Pathak, Sankalp; Patel, Ankita; Vaidya, Pranaychandra

doi:10.1016/j.hrtlng.2021.01.007

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…The name Takotsubo comes from the Japanese term for a unique octopus trap, which describes the apical ballooning appearance of the left ventricle typically in response to a stressor that induces significant regional cardiomyopathy [8]. Despite multiple possible etiologies of Takotsubo cardiomyopathy, very few cases report intracranial hemorrhage as an underlying cause [9][10][11][12]. One prospective study by Molnar et al estimates the incidence of severe Takotsubo cardiomyopathy in SAH cases at approximately 8% [13].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome

et al. 2022

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Intracranial bleeds, such as subarachnoid hemorrhage, carry high morbidity and mortality rates. Often intracranial hemorrhages result in debilitating residual neurological symptoms but can be so extensive that cardiac complications can also be seen. We present a rare case of a patient who was found to have a subarachnoid hemorrhage that incited the development of Takotsubo cardiomyopathy, which subsequently progressed to an acute myocardial infarction. The aim of this case report is to explore the underlying pathophysiology of how cerebral hemorrhage can result in apical ballooning of the left ventricle through various mechanisms including sympathetic-induced surge in catecholamines and neurogenic damage to the myocardium. We also intend to highlight the importance for clinicians to consider brain bleeds in the differential diagnosis when a patient presents with an acute myocardial infarction as treatment with heparin is generally contraindicated.

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Section: Discussionmentioning

confidence: 99%

An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome

et al. 2022

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“…However, it is recommended to avoid dobutamine in patients with severe systolic dysfunction or LVOT obstruction with hypotension and shock [34]. When mechanical support is available, left ventricle assist devices, intra-aortic balloon pump support, and extracorporeal membrane oxygenation can be considered [35,36]. In stable patients, diuretics and vasodilators can be used for pulmonary congestion [32].…”

Section: Table 3: International Takotsubo Diagnostic Criteriamentioning

confidence: 99%

Takotsubo Cardiomyopathy (TCM) After Uncomplicated Paraesophageal Hernia Repair: A Case Report and Review on Postoperative TCM

Kan¹,

Rich²,

Brown³

et al. 2023

Cureus

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Takotsubo cardiomyopathy (TCM) is a rare stress-induced condition that appears rarely in suspected acute myocardial infarction cases. It causes unexplained left ventricular failure, but most cases are reversible with supportive treatment. In this report, we present the case of a 70-year-old female who developed acute hypotension after a laparoscopic Toupet fundoplication on postoperative day one, requiring care in the surgical intensive care unit. Following consultation with the cardiology service and further imaging and tests, she was diagnosed with TCM. This report outlines the potential mechanisms and management of TCM in the intensive care unit, emphasizing the importance of prompt diagnosis and treatment.

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“…In recent years, it has been increasingly suggested that microaxial LVADs may be of particular value in the treatment of CS caused by TTS, as they enable venting of the left ventricle [21][22][23]. There is thus a growing interest to evaluate patients with TTS-CS who have been treated with Impella [24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review

von Mackensen,

Zwaans,

El Shazly

et al. 2024

JCM

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Background: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. Methods: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. Results: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). Conclusions: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.

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Successful use of the impella ventricular assist device for management of reverse Takotsubo Cardiomyopathy in the setting of acute intracranial hemorrhage

Cited by 5 publications

References 11 publications

An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome

An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome

Takotsubo Cardiomyopathy (TCM) After Uncomplicated Paraesophageal Hernia Repair: A Case Report and Review on Postoperative TCM

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review

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