Takotsubo Cardiomyopathy and Left Ventricular Outflow Tract Obstruction
PAUL FEFER M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorANJALA CHELVANATHAN M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorALEXANDER J. DICK M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorEARL J. TEITELBAUM M.D.
North York General Hospital, Toronto, Ontario, Canada
Search for more papers by this authorBRADLY H. STRAUSS M.D., Ph.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorERIC A. COHEN M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorPAUL FEFER M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorANJALA CHELVANATHAN M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorALEXANDER J. DICK M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorEARL J. TEITELBAUM M.D.
North York General Hospital, Toronto, Ontario, Canada
Search for more papers by this authorBRADLY H. STRAUSS M.D., Ph.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorERIC A. COHEN M.D.
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAbstract
Takotsubo cardiomyopathy often presents to the cardiac catheterization laboratory masquerading as acute ST-elevation myocardial infarction (STEMI). Some of these patients present in shock secondary to dynamic left ventricular outflow tract (LVOT) obstruction. The typical patient is an elderly, hypertensive female with sigmoid deformity of the intraventricular septum. The management of hemodynamic instability in these patients is different from patients with STEMI. While hemodynamic instability in the setting of STEMI is usually treated with inotropic agents and intraaortic balloon counterpulsation, these therapies can increase LVOT pressure gradients in patients with takotsubo cardiomyopathy and lead to deepening of shock and worse outcomes. Thus accurate diagnosis and correct management are essential to prevent mortality in these patients, who will usually go on to have good long-term outcomes. This case report and literature review addresses the clinical characteristics, outcome, and management of these patients.
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