Takotsubo Cardiomyopathy Induced by Dobutamine Infusion: A New Phenomenon or an Old Disease with a New Name

Mosley, William J.; Manuchehry, Amin; McEvoy, Colleen; Rigolin, Vera H.

doi:10.1111/j.1540-8175.2009.01089.x

Cited by 29 publications

(16 citation statements)

References 8 publications

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“…Treatment of hypotension in TTC is challenging both in theory and practice. Administration of most vasopressor or inotropic agents could potentially aggravate the condition and theoretically should be avoided. Therefore, in cases of severe shock, insertion of an intra‐aortic balloon pump (IABP) has become the “default” management option.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, episodes of TTC appear to be precipitated by unusual physical or emotional stress, associated with marked release of catecholamines . Similarly, TTC may occur as a complication of exogenous catecholamine administration . Functionally, TTC is associated with regional (usually periapical) impairment of left ventricular (LV) systolic function, which is potentially reversible.…”

Section: Introductionmentioning

confidence: 99%

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Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension

Chong¹,

Neil²,

Nguyen³

et al. 2013

Clinical Cardiology

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Background: Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias. Hypothesis: We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction. Methods: In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis. Results: Mean systolic blood pressure (SBP) on day 1 was 120 ± 24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90 mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inversely with pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T 2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation). Conclusions: Although severe hypotension and shock occur commonly during acute stages of TTC, these complications are multifactorial in origin, probably representing a combination of impaired inotropic state and vasodilatation. Importantly, initial hypotension does not imply severe left ventricular inflammation or systolic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension

Chong¹,

Neil²,

Nguyen³

et al. 2013

Clinical Cardiology

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“…Few cases of Takotsubo cardiomyopathy induced by dobutamine stress echocardiography (DSE) have been reported. Still the pathophysiology of this syndrome remains undetermined . In this specific setting, intracoronary imaging modalities have not been undertaken as only coronary angiography has been used to define whether there is coronary vessel involvement.…”

mentioning

confidence: 99%

The Role of Optical Coherence Tomography in Clarifying the Mechanisms for Dobutamine Stress Echocardiography‐Induced Takotsubo Cardiomyopathy

et al. 2013

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Takotsubo cardiomyopathy is a clinical disorder characterized by a transient dilatation and akynesis or dyskinesis of the left ventricular (LV) apex, mimicking an anterior wall acute myocardial infarction in the absence of significant coronary artery disease (CAD). It typically occurs during an episode of severe emotional or physical stress. Recent reports suggested the potential of dobutamine stress echocardiography (DSE) in inducing the aforementioned syndrome. The transient dysfunction of the LV does not fit any known coronary distribution. Furthermore, there is no obstructive CAD demonstrated at angiography to account for the observed dysfunction. Consequently, the pathophysiology of this syndrome is still undetermined. Here, we report a case of DSE-induced Takotsubo cardiomyopathy in which high-resolution intracoronary imaging was utilized to exclude possible vessel alterations to help provide potential mechanistic explanations for the development of this condition.

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“…The clinical challenge now arises as catecholamine surge is believed to contribute to the pathophysiology of stress-induced cardiomyopathy 7. Takotsubo cardiomyopathy has also been reported after dobutamine infusion 13. We believe, in such situations, use of mechanical support devices may provide more benefit compared with using medications that may worsen the cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Use of the Impella 2.5 left ventricular assist device in a patient with cardiogenic shock secondary to takotsubo cardiomyopathy

et al. 2015

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We report a case of cardiogenic shock, believed to be secondary to stress-induced cardiomyopathy, managed by an Impella 2.5 assist device. Apical ballooning pattern was evident on left ventriculogram with no significant coronary artery disease on coronary angiography. Cardiogenic shock was initially managed medically with inotropes and vasopressors, but because the patient was clinically deteriorating, an Impella 2.5 left ventricular assist device was implanted. Remarkable recovery occurred within 48 h of implantation with significant increase in ejection fraction and only minimal residual apical hypokinesis observed on repeat ventriculogram.

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Takotsubo Cardiomyopathy Induced by Dobutamine Infusion: A New Phenomenon or an Old Disease with a New Name

Cited by 29 publications

References 8 publications

Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension

Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension

The Role of Optical Coherence Tomography in Clarifying the Mechanisms for Dobutamine Stress Echocardiography‐Induced Takotsubo Cardiomyopathy

Use of the Impella 2.5 left ventricular assist device in a patient with cardiogenic shock secondary to takotsubo cardiomyopathy

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