Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Takotsubo Cardiomyopathy (n=1). Intervention: Hemodynamic management (preload optimization, alpha-1 agonists, avoiding afterload reduction). Primary outcome: Clinical recovery and hemodynamic stabilization.

Q: What does this research mean for the field?

In Takotsubo cardiomyopathy complicated by dynamic LVOT obstruction and cardiogenic shock, tailored hemodynamic management prioritizing preload optimization and alpha-1 agonists while avoiding afterload reducers leads to clinical stabilization. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Avilash Mondal; Sittinun Thangjui; Amro Taha; Justin Conte; Abhiram Challa; Sudarshan Balla; Robert W Biederman

doi:10.1016/j.jaccas.2026.109101

July 1, 2026JACC Case ReportsOpen Access

Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI

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Key result

Tailored management prioritizing preload and alpha-1 agonists stabilizes cardiogenic shock from dynamic LVOT obstruction.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Takotsubo syndrome can present with ST-segment elevation mimicking STEMI and may involve dynamic LVOT obstruction causing cardiogenic shock, complicating diagnosis and management.

Key Points

To describe the presentation, hemodynamic assessment, and targeted therapeutic management of Takotsubo syndrome complicated by dynamic left ventricular outflow tract obstruction and shock mimicking inferior STEMI.
Evaluated a 64-year-old woman presenting with hypotension, elevated high-sensitivity troponin-I (116.3 ng/L), and inferior ST-segment elevation on serial electrocardiograms.
Conducted emergent coronary angiography, left ventriculography, invasive left ventricular-aortic pressure pullback, and transthoracic echocardiography.
Administered phenotype-specific shock therapy focusing on alpha-1 adrenergic vasopressors and rapid de-escalation of afterload-reducing mechanical support.
Coronary angiography showed no obstructive coronary artery disease, whereas ventriculography revealed apical and mid-ventricular akinesis with basal hyperkinesis.
Echocardiography demonstrated systolic anterior motion of the mitral valve, dynamic left ventricular outflow tract obstruction with a peak gradient of 48 mm Hg, and an ejection fraction of 37%.
Treatment with alpha-1 agonist agents and de-escalation of intra-aortic balloon pump augmentation facilitated shock resolution, extubation within 24 hours, and subsequent stable discharge.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 64-year-old woman presenting with cardiogenic shock and dynamic left ventricular outflow tract obstruction due to Takotsubo cardiomyopathy mimicking inferior STEMI.

I

Intervention

Hemodynamic management guided by echocardiography, including preload optimization (fluid resuscitation), transition from inotropes/beta-agonists to an alpha-1 agonist (phenylephrine) for pure afterload support, and de-escalation of intra-aortic balloon pump (IABP) support to minimize afterload reduction.

O

Outcome

Clinical stabilization and recovery from cardiogenic shock.

In patients with Takotsubo syndrome complicated by cardiogenic shock, early recognition of dynamic LVOT obstruction is crucial to avoid standard shock therapies that may worsen hemodynamics, favoring instead preload optimization and alpha-adrenergic vasopressors.

Limitations

Findings are based on a single patient case report

Implication

May inform shock management in Takotsubo with LVOT obstruction; leaves open prospective validation.

Abstract

BACKGROUND: Takotsubo syndrome can present with ST-segment elevation, mimicking acute coronary syndrome. Dynamic left ventricular outflow tract (LVOT) obstruction often is a hemodynamic collapse in these patients. CASE SUMMARY: , followed by acute inferior ST-segment elevation and reciprocal changes. Coronary angiography revealed no obstructive disease; however, there was global hypokinesia with basal hyperkinesis in left ventriculography. She developed cardiogenic shock requiring vasopressors, and decision was made to place a balloon pump for hemodynamic support. Echocardiography demonstrated systolic anterior motion of the mitral valve and dynamic LVOT obstruction (peak gradient 48 mm Hg). Alpha-1 agonist agents led to clinical improvement and stable discharge. DISCUSSION: In Takotsubo syndrome, identifying LVOT obstruction, avoiding afterload reducers, and optimizing preload are key. TAKE-HOME MESSAGE: In electrocardiogram-based ST-segment elevation myocardial infarction, Takotsubo syndrome must be considered as a differential.

Discussion

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Cite This Study

Mondal et al. (2026) conducted a case report in Takotsubo Cardiomyopathy (n=1). Hemodynamic management (preload optimization, alpha-1 agonists, avoiding afterload reduction) was evaluated on Clinical recovery and hemodynamic stabilization. Hemodynamic management tailored to dynamic LVOT obstruction, prioritizing preload optimization and alpha-1 agonists while avoiding afterload reducers, led to clinical stabilization and recovery.

synapsesocial.com/papers/6ad0fc513afa093ea9acfd9b https://doi.org/10.1016/j.jaccas.2026.109101

Topics

Heart failure

HFrEF treatment

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Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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