Role of a dynamic LVOT obstruction in the pathogenesis of takotsubo syndrome

Abstract

Pavlovič J, Hlaváček K, Feuereisl R, et al. Role of a dynamic LVOT obstruction in the pathogenesis of takotsubo syndrome. Cor Vasa 2010;52:695-699.Aims: To explore the possible causative relationship between a dynamic left ventricular outfl ow tract (LVOT) obstruction and takotsubo syndrome. Methods and results:We analyzed a group of eleven patients with takotsubo syndrome. In this article, we focus on one patient developing a less common variant of takotsubo (stress) syndrome after a situation creating a decreased preload, but without a preceding stressful event (either psychological or physical). Coincidently we found a dynamic obstruction of left ventricular outfl ouw tract and septal bulge mimicking the pattern of hypertrophic cardiomyopathy. After the contraction abnormalities had normalized, we performed a provocation test with nitroglycerin on follow-up inducing the obstruction. An exercise stress test performed on follow-up showed a good eff ect of conservative treatment. The relevant literature was reviewed. Conclusion: We suggest a possible primary pathogenetic role of a dynamic LVOT obstruction in the development of takotsubo syndrome. Pavlovič J, Hlaváček K, Feuereisl R, et al. Úloha dynamické obstrukce LVOT v patogenezi tako-tsubo syndromu. Cor Vasa 2010;52:695-699. Cíl: Zjistit možnou příčinnou souvislost mezi dynamickou obstrukcí LVOT a tako-tsubo syndromem. Metodika a výsledky: Analyzovali jsme skupinu jedenácti pacientů s tako-tsubo syndromem. V tomto článku zaměřujeme pozornost na pacientku, u které se rozvinula méně častá varianta tako-tsubo syndromu v souvislosti se situací vytvářející snížení preloadu, přičemž nepředcházela žádná stresová událost (psychická ani fyzická). Současně byla zjištěna dynamická obstrukce výtokového traktu levé komory a septum sigmoideum imitující obraz hypertrofi cké kardiomyopatie. Jakmile došlo k plné úpravě všech poruch kontraktility, provedli jsme, při ambulantní kontrole, provokační test s nitroglycerinem a vyvolali jsme obstrukci výtokového traktu levé komory. Ergometrie provedená s odstupem při ambulantní kontrole potvrdila dobrý účinek konzervativní léčby. Shromáždili jsme a prostudovali tematicky související literaturu. Závěr: Ukazujeme na možnou primární patogenetickou úlohu dynamické obstrukce výtokového traktu levé komory v rozvoji tako-tsubo syndromu. Klíčová slova: Tako-tsubo syndrom -Obstrukce LVOT -Septal bulge -Hypertrofi cká kardiomyopatie Address: MUDr. Jan Pavlovič, Kardiologie na Bulovce, s. r. o.,

Tako-tsubo syndrome and atrial fibrillation. New trigger for cardiomyopathy. A clinical case

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The "golden standard" for a defi nitive diagnosis is invasive coronary angiography and ventriculography, with an integrated multi-imaging approach, such as echocardiography, fi rst--line non-invasive technique, and cardiac magnetic resonance (CMR), in order to discriminate TS from other acute cardiac syndromes with troponin elevation and ventricular disfunction. [16][17][18][19] Important hallmarks of TS are a relatively small increase in T/I troponin, the left ventricle "apical ballooning" (wall motion diskinesis characterized by apical akinesis and basal hyperkinesis) at echocardiography and ventriculography associated with normal epicardial coronary vessels at angiography. 3,7,14,[19][20][21][22] In addition there may be catecholamines (epinephrine, norepinephrine, and dopamine) and NT-proBNP elevation.…”

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

“…This condition mimics an acute myocardial infarction (AMI) because of the symptoms and the new onset of ST segment elevation and/or negative T waves, but without fi ndings of acute obstructive coronary artery disease at angiography, although these can be present in 10-29% of cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The diagnosis is made with invasive coronary angiography and ventriculography, together with transthoracic echocardiography which can show different patterns: typical "apical ballooning" of the left ventricle (LV), characterized by apical akinesis and hyperkinesis of the basal segments, or atypical patterns, including the midventricular, basal, and focal wall motion patterns, all of these with reduced ejection fraction. 20 The exact mechani- sm of TTS is unknown, but it is hypothesized that a sudden massive surge of circulatory catecholamines (adrenaline, noradrenaline) from a physical or emotional stress may play a central role.…”

“…20 The exact mechani- sm of TTS is unknown, but it is hypothesized that a sudden massive surge of circulatory catecholamines (adrenaline, noradrenaline) from a physical or emotional stress may play a central role. 5,18,[21][22][23][24][25] TTS is responsible for 2% of all acute coronary syndrome cases presenting to hospitals and most of the patients are women in post-menopausal age. 26,27 It is generally a self-limiting disease, spontaneously resolving in days or weeks.…”