Therapeutic Challenges in Combined Apical Ballooning Syndrome and Acute Pulmonary Decompensation

Abstract

Apical ballooning syndrome (ABS) is increasingly diagnosed in critical care settings. Widespread application of echocardiography and cardiac enzyme testing has increased its recognition. Our experience of 4 subjects illustrates the association of ABS with a wide spectrum of acute pulmonary disorders seen in critical care settings. All had ABS proven by normal coronary angiogram and subsequent normalization of left ventricular dysfunction. Bronchospasm due to chronic obstructive pulmonary disease exacerbation or cardiac failure warrants the use of beta agonists. ABS, on the other hand, being caused by excess sympathetic activity could potentially improve with beta blockade. Coexistence of ABS and pulmonary disease in critical-care settings presents unique therapeutic challenges and outcomes can be optimized by judicious use of available medical options.

Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms

“…Mayo criteria for SC diagnosis requires coronary angiogram to confirm absence of culprit lesions that may account for the RWMA 7, 11. Our interest is in early non-invasive diagnosis of SC in the critically ill. We have reviewed the various etiologies of cardiac dysfunction in the critically ill 12 and highlighted management issues specific to the critically ill 13, 14. We routinely encounter potential SC in various ICU settings and have published our algorithm to definitively diagnose SC without catheterization 9 .…”

Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?

“…Takotsubo cardiomyopathy (TCM) associated with chronic obstructive pulmonary disease (COPD) is considered a subset of TCM, suggesting a dangerous liaison of the heart-lung axis [ 1 - 3 ]. Manfredini, et al reported a high prevalence of lung pathologies, including asthma, COPD, and pulmonary embolism in a retrospective analysis of patients suffering from TCM [ 2 ].…”