Acute Left Ventricular Ballooning: Tools to Differentiate Hypertrophic Cardiomyopathy with Outflow Obstruction from Neurohumoral Takotsubo Syndrome

Abstract

Despite considerable interest in the syndrome of acute left ventricular (LV) ballooning, its pathophysiology has remained ill-defined. In this review, we explore observational data describing two etiologies of acute LV ballooning: neurohumoral classic Takotsubo Syndrome (TTS), and acute severe unrelenting left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (HCM). We describe the clinical presentation and varying pathophysiology of these presentations, explore how echocardiography and cardiac catheterization may help differentiate between the two etiologies, and detail differences in management. We highlight the significant overlap as well as key differentiating features of these conditions, with the aim to improve diagnostic awareness and accuracy and appropriately tailor therapy.

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“…7 Although echocardiography is the mainstay of noninvasive evaluation of patients with HCM, catheterization-based techniques are essential and underutilized. 8,9 We have noticed a tendency from some institutions to not perform LV pressure measurements during coronary angiography of patients with HCM and other cardiomyopathies, including Takotsubo, which is unfortunate given the etiologic data that can be gleaned, 9 especially since these are myocardial diseases.…”