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Dynamic left ventricular outflow tract gradient resulting from Takotsubo cardiomyopathy ameliorated by intra-aortic balloon pump counterpulsation: a case report

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journal contribution
posted on 26.05.2021, 16:16 by Jim O'Brien, Stephen Mahony, Roger J Byrne, Robert Byrne

Background: Takotsubo cardiomyopathy is a variant of acute coronary syndrome with characteristic acute left ventricular apical ballooning. Uncommonly, there can be associated left ventricular outflow tract (LVOT) obstruction causing cardiogenic shock refractory to inotropic support. The use of afterload-reducing mechanical support such as intra-aortic balloon pump (IABP) counterpulsation is not routinely employed in instances of this kind.

Case summary: In our case report, we describe a 66-year-old female with acute Takotsubo cardiomyopathy and associated LVOT obstruction which failed to respond to high-dose dobutamine and whose clinical trajectory was worsened by fast atrial fibrillation with rapid ventricular response. Within 24 h of admission, the patient had an IABP placed which rapidly improved her haemodynamics. Two days later, IABP was removed and within 6 days of admission, apical ballooning and LVOT obstruction had fully recovered.

Conclusion: We recommend early use of mechanical support with IABP counterpulsation to expedite recovery in patients with acute Takotsubo cardiomyopathy with associated LVOT obstruction.

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The original article is available at https://academic.oup.com

Published Citation

O'Brien J, Mahony S, Byrne RJ, Byrne RA. Dynamic left ventricular outflow tract gradient resulting from Takotsubo cardiomyopathy ameliorated by intra-aortic balloon pump counterpulsation: a case report. Eur Heart J Case Rep. 2021;5(3):ytab082.

Publication Date

3 March 2021

PubMed ID

33718770

Department/Unit

  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Vascular Biology

Publisher

Oxford University Press (OUP)

Version

  • Published Version (Version of Record)