Use of vasopressors in Takotsubo cardiomyopathy: a cautionary tale

Abstract

Grade 1C)'. It assumes equal risk for a lumbar plexus block when compared with an upper limb plexus block and does not consider the potential benefits of ultrasound in mitigating vascular injury.In the absence of robust evidence, it is our assertion that, by identifying current practice across the country, confidence can be gained that we are operating in a way similar to our colleagues. Thus, it allows the application of the Bolam principle. For upper limb blocks, the authors recommend:(i) ultrasound-guided technique in patients with altered coagulation; (ii) INR ,2.5 (88% concordance); (iii) platelet count ≥50 000 (65% concordance); (iv) concomitant use of clopidogrel is not necessarily a contraindication (50% concordance); (v) a national audit project similar to the Royal College of Anaesthetists' third national audit project, identifying major complications of central neuraxial blockade, would be of benefit.

'GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI

“…Clinicians, however, are often faced with a dilemma when cardiac catheterization and thrombolytic therapy are relatively contraindicated, unavailable or can cause potential adverse consequences. 3 Meanwhile, in patients presenting with hemodynamic instability, misdiagnosing TCM as STEMI will potentially lead to initiation of harmful pharmacological or device treatment leading to worsening hemodynamic compromise 4 . Therefore, distinguishing TCM from AMI in the absence of invasive procedures remains crucial and variously attempted in recent literature.…”

Peri-Operative Takotsubo Cardiomyopathy: A Case Series

“…The onset of TC is triggered by a stressful or emotional event in about 90% of patients.2 Catheterization is required to confirm diagnosis. Pathognomonic for TC is LV apical wall ballooning (not corresponding to any specific coronary artery territory3) in the presence of normal coronary arteries; there is a lack of CAD on angiography [5].…”

“…Curiously, women are found to have higher odds of developing TC (ratio to men of >6:1) [7], and women > 55yo 4.8 times higher vs. women < 55yo.4 Asian and Caucasian women are thought to have a higher incidence [5]. Contributing factors to this are thought to be smaller left ventricular size, hormonal disturbances, and decreasing vagal tone and baroreflex sensitivity in postmenopausal women [7].…”

“…Rarely, complications can occur such as cardiac arrhythmias, congestive heart failure, hypotension, Torsade de Pointes, mitral regurgitation, left-sided heart failure, left ventricular thrombosis, and death (mortality ranging between 1-3%) [5,8,9]. Fortunately TC carries a favorable prognosis.…”

“…Interventions can vary from supportive care with medication management to intraaortic balloon pump in those having acute LV failure [6]. Typically, LV function is restored within days to weeks, with 33% of patients having spontaneous recovery of LV function by the time of discharge [6], and 95% of patients experiencing a full recovery within 4-8 weeks, and mortality being <2% [5,8]. Interestingly, the recurrence rate of TC is estimated anywhere from 3-10% [1,6,9,10].…”