Takotsubo Cardiomyopathy in a Patient with Previously Undiagnosed Hypertrophic Cardiomyopathy with Latent Obstruction

Abstract

A 62-year-old woman with takotsubo cardiomyopathy (TCM) accompanied by cardiogenic shock due to the obstruction of left ventricular outflow tract (LVOT) and massive mitral regurgitation (MR) was admitted to the emergency department. After successful treatment with intensive care, dobutamine stress-echocardiography was performed, which reproduced a dynamic LVOT gradient, severe MR and cardiogenic shock. A histological examination obtained from the right ventricular septum demonstrated hypertrophied and bizarre myocytes, with myocyte disarray. Besides TCM, a diagnosis of preexisting hypertrophic cardiomyopathy with latent obstruction was made. She was discharged with medical therapy including a beta-blocker, which would not be routinely employed in the treatment of a patient with TCM.

Intra-Aortic Balloon Pump Exacerbates Left Ventricular Outflow Tract Obstruction in a Patient With Takotsubo and Hypertrophic Cardiomyopathy

“… 3 , 4 This combination can lead to hemodynamic compromise and shock, mainly through increasing LVOT obstruction, but alternative mechanisms, such as a reduction in systemic vascular resistance, have also been postulated. 5 , 6 , 7 Sherrid et al . 8 described a case series of 14 patients with HCM who developed cardiogenic shock associated with apical ballooning and high LVOT gradients.…”

Recurrent Takotsubo Cardiomyopathy in a Patient With Hypertrophic Cardiomyopathy Leading to Cardiogenic Shock Requiring VA-ECMO

“…There are only 4 other reported cases of patients with HCM presenting with takotsubo cardiomyopathy who developed cardiogenic shock ( Table 2 ) ( 2 , 3 , 4 , 5 ). To the best of our knowledge, the first such case was reported in 2011 ( 2 ), and we report only the second published case of a patient requiring the use of VA-ECMO.…”

“… Intervention: phenylephrine for shock, then medical therapy Vital status: discharged home 3 days after presentation Arakawa et al. (2018) ( 4 ) Internal Medicine A 62-year-old woman with a family history of obstructive HCM presented with chest pain and developed cardiogenic shock treated by norepinephrine infusion. Cardiac catheterization diagnosed takotsubo cardiomyopathy with a 50 mm Hg LVOT gradient.…”

Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning?

“…Additional evidence comes from reports of 7 patients admitted with LV ballooning who, after clinical recovery and normalization of LV function, had provocation with dobutamine stress echocardiography. 33 , 34 , 35 At dobutamine stress echocardiography, these 7 patients developed high LV outflow gradients due to SAM and mitral–septal contact in the absence of LV ballooning. This indicates that the SAM was not due to a geometric change in LV shape or basal hyperkinesia.…”