A case of ultrashort‐acting beta‐blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction

Abstract

Takotsubo syndrome ( TTS ) has been known to have a favorable prognosis. Beta‐blockers are reported to be effective for TTS patients with cardiogenic heart failure due to left ventricular outflow tract ( LVOT ) obstruction. However, there is no report on ultrashort‐acting beta‐blockers being used for treating TTS , and there are no clear guidelines for their dosages or applications. Herein, we describe a 72‐year‐old woman in whom landiolol hydrochloride was used in the acute phase of TTS with LVOT obstruction. In this case, the dose of landiolol hydrochloride was increased to 10 μg/kg/min, resulting in improvement of LVOT obstruction, which led to hemodynamic stabilization.

Perioperative management of Takotsubo cardiomyopathy: an overview

“…In terms of pharmacological treatment, the drugs commonly used for heart failure include ACE inhibitors, β-blockers and diuretics; these are cornerstones of the management of myocardial dysfunction in stress cardiomyopathy [ 83 ]. In particular, β-blockers have a role in reducing the extent of LVOT obstruction [ 84 ]. The rationale for their use can be understood in relation to the role that alpha and β-adrenergic stimulation has in the pathogenesis of stress cardiomyopathy; they exert their clinical effect by reducing the contractility at the base of the heart and by facilitating the diastolic filling of the left ventricle.…”

Takotsubo Cardiomyopathy: Current Treatment

“…On the other hand, precipitation of TTS by withdrawal of metoprolol in a patient has occurred [ 34 ], although that patient had LV outflow tract obstruction (LVOTO), where the β-blocker was indicated. Various cardioselective β 1 -blockers (e.g., metoprolol [ 35 ], bisoprolol, esmolol [short-acting] [ 21 , 36 ], landiolol [ultrashort-acting]) [ 37 , 38 , 39 ], non-cardioselective (propranolol) [ 40 , 41 ] or non-cardioselective β-blockers with associated α 1 -blocking effects (e.g., carvedilol or labetalol [ 40 ] have been used in patients with TTS, but no head-to-head comparisons of these drugs have been undertaken. There is also literature supporting the view that β-blockers are not beneficial in patients with TTS [ 42 ], as also shown by the reports revealing that a sizeable proportion of patients on a maintenance therapy with β-blockers have suffered TTS [ 43 ].…”

“…Accordingly, it has been recently proposed that large doses of insulin infusions, in connection with careful monitoring to prevent hypoglycemia and hypokalemia, via concomitant infusions of dextrose and potassium supplementation, in conjunction with intravenous use of short-, or ultrashort-acting β-blockers (e.g., esmolol or landiolol) [ 39 ] ( Figure 7 ) perhaps have beneficial therapeutic effects in patients with TTS [ 10 , 11 ], addressing specifically the devastating metabolic impairment (glucose and lipid pathways dysregulation, leading to decreased final glycolytic and β-oxydation metabolites and reduced availability of Krebs intermediates), noted in TTS [ 117 , 118 ]. This proposal is based on previous literature of animal models of stress cardiomyopathy, recently summarized [ 10 ], and limited experience in patients with neurogenic cardiomyopathy and TTS [ 37 , 38 , 119 , 120 , 121 , 122 ] ( Figure 8 ). Consequently.…”

“…Reproduced and modified from Ref. [ 38 ], with the permission of Journal of General and Family Medicine.…”