Bedside echocardiography is crucial in hemodynamically unstable Takotsubo cardiomyopathy to identify acute mitral regurgitation and LVOTO, as standard therapies like vasodilators or inotropes can exacerbate the condition.
Nitrates may precipitate instability in Takotsubo cardiomyopathy; this case leaves open the need for echocardiography-guided management strategies.
Takotsubo cardiomyopathy (TTC) is a well-recognised entity that commonly manifests with chest pain, ST segment abnormalities and transient left ventricular apical ballooning without coronary artery obstructive disease. This syndrome usually portends a favourable outcome. In the rare haemodynamically unstable TTC patients, acute mitral regurgitation (MR) related to systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) is to be considered. Bedside echocardiography is key in recognition of this latter condition as vasodilators, inotropic agents or intra-aortic balloon counter-pulsation worsen the patient's clinical status. We discuss here a case of TTC where nitrate-induced subaortic obstruction and mitral regurgitation led to haemodynamic instability.
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Bouabdallaoui et al. (2014) studied this question.
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