In patients with Takotsubo cardiomyopathy and LVOT obstruction, standard STEMI shock therapies like inotropes and IABP should be avoided as they can worsen the obstruction and deepen shock.
May warrant caution with inotropes and IABP in Takotsubo with LVOT obstruction; hypothesis-generating and should not yet change practice.
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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Fefer et al. (2009) studied this question.
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