Takotsubo Cardiomyopathy and Left Ventricular Outflow Tract Obstruction

Fefer, Paul; Chelvanathan, A.; Dick, Alexander; Teitelbaum, Earl J.; Strauss, B.H.; Cohen, Éric A.

doi:10.1111/j.1540-8183.2009.00488.x

Cited by 40 publications

(20 citation statements)

References 27 publications

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“…20 21 An additional variant of takotsubo cardiomyopathy called left ventricular outflow tract (LVOT) obstruction is seen in 25% of cases 22. These patients usually present with severe cardiogenic shock and great caution should be taken when administering inotropes to reverse hypotension (dobutamine), since this can worsen haemodynamics by increasing the outflow tract obstruction 22 23. A few reports described RV dysfunction in takotsubo cardiomyopathy associated with extreme clinical characteristics involving bilateral pulmonary oedema, which requires aggressive treatment 24…”

Section: Clinical Featuresmentioning

confidence: 99%

Takotsubo cardiomyopathy: pathophysiology and treatment

Milinis

Fisher

2012

Postgraduate Medical Journal

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Since it was first described 20 years ago in Japan, takotsubo cardiomyopathy has received considerable interest from the medical community around the world, particularly in recent years. Although takotsubo cardiomyopathy was originally described as a transient, stress-induced dysfunction of the left ventricular apex, other morphological subtypes have now been described. The pathogenesis of this disorder is likely to be catecholamine mediated myocyte damage and microvascular dysfunction; however, a number of possible alternative theories have been suggested. These include oxidative stress, transient coronary obstruction and oestrogen deficiency, the last explaining the high prevalence of takotsubo cardiomyopathy in women. The treatment remains largely supportive; however, a number of agents have been implicated in the acute stage and long term. Although most of the patients show complete recovery, there is a high risk of complications at the initial presentation requiring intense support.

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Section: Clinical Featuresmentioning

confidence: 99%

Takotsubo cardiomyopathy: pathophysiology and treatment

Milinis

Fisher

2012

Postgraduate Medical Journal

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“…Die Pathophysiologie der Obstruktion des LVOT bei TTC ähnelt der einer hypertrophen obstruktiven Kardiomyopathie, kann die hämodynamische Instabilität und das Ausmaß der Herzinsuffizienz der betroffenen Patienten verstärken und hat Bedeutung für die Wahl der Therapie. Die Diagnose eines dynamischen Gradienten des LVOT erfolgt mittels Herzkatheteruntersuchung oder Echokardiographie [33]. Die Prävalenz dieses Phänomens bei Patienten mit TTC wird mit Werten zwischen 4% und 25% angegeben [1,3,27,34].…”

Section: Ausflusstraktobstruktion Akute Mitralinsuffizienzunclassified

“…B. der Gabe von β-Mimetika oder der Initiierung einer IABP-Therapie. Beide Maßnahmen können dabei in einer Zunahme des intraventrikulären Gradienten und einer Verschlechterung der Hämodynamik resultieren [33]. Mittlerweile liegen erste Erfahrungen zum Einsatz des Calciumsensitizers Levosimendan und (als Ultima Ratio) eines kardialen Assist-Device bei TTC-Patienten mit kardiogenem Schock vor [54,55].…”

Section: Introductionunclassified

Patientenversorgung in der akuten Phase der stressinduzierten Kardiomyopathie (Tako-Tsubo-Kardiomyopathie) – und danach?

Kurowski

Radke

Schunkert

et al. 2010

Herz

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The prognosis of patients presenting with Tako-Tsubo cardiomyopathy (TTC) is generally considered to be favorable. However, in the acute phase of the disorder complications are not infrequent and, therefore, continuous monitoring and consistent therapy in an intensive care unit is essential. Typical complications in patients with TTC are cardiogenic shock, obstruction of the left ventricular outflow tract (LVOT), occasionally accompanied by acute mitral regurgitation, arrhythmias, predominantly torsade de pointes tachycardias due to QT prolongation, left ventricular (LV) thrombus formation with or without consecutive thromboembolic events, and LV rupture. After confirmation of TTC by coronary angiography, repeat echocardiography should be performed. A standardized therapy for patients with TTC has so far not been established. Recommendations for the acute phase include the administration of anxiolytic agents for patients who present with preceding emotional stress, consistent therapy of physical stressors (such as pain or asthma) and avoidance of catecholamine therapy. Shock due to LVOT obstruction is treated by administration of volume and β-blockers. With respect to the occurrence of torsade de pointes tachycardias, drugs which might cause QT prolongation should not be given. The notable incidence of LV thrombus formation justifies therapeutic anticoagulation. Systematic studies and treatment recommendations for the prophylaxis of recurrent TTC do not exist. The recently reported association between TTC and malignant disorders should prompt tumor screening and subsequent preventive medical checkups in patients affected by TTC.

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“…Mehrere Autoren beschreiben eine dynamische LVOT-Obstruktion ohne Vorliegen einer relevanten LV-Hypertrophie im Rahmen einer akuten myokardialen Ischämie infolge eines Myokardinfarkts oder einer Tako-Tsubo-Kardiomyopathie [2,3], eine schwerwiegende Komplikation, die zu einem kardiogenen Schock oder zur Myokardruptur führen kann [3].…”

Section: Diagnostikunclassified