Pressure tracings in obstructive Tako-Tsubo cardiomyopathy
Satoshi Kurisu1, Ichiro Inoue, Takuji Kawagoe
1Department of Cardiology, Hiroshima City Hospital 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. skurisu@nifty.com <skurisu@nifty.com>
European Journal of Heart Failure
|October 10, 2006
Summary
Severe anxiety triggered Tako-Tsubo cardiomyopathy in a 70-year-old woman. The condition caused a dynamic left ventricular outflow tract obstruction, which resolved with treatment.
Area of Science:
- Cardiology
- Cardiomyopathy
Background:
- Stress-induced cardiomyopathy, or Tako-Tsubo cardiomyopathy (TTC), is a transient cardiac dysfunction often triggered by emotional or physical stress.
- This case highlights a rare presentation of TTC with significant dynamic left ventricular outflow tract (LVOT) obstruction.
Observation:
- A 70-year-old female presented with chest discomfort 16 hours after a stressful event.
- Initial investigations revealed left ventricular apical ballooning and hyperkinesis of the base, characteristic of TTC, with no coronary artery disease.
- Hemodynamic monitoring demonstrated a significant and dynamic systolic pressure gradient across the LVOT, exacerbated by premature ventricular contractions.
Findings:
- Tako-Tsubo cardiomyopathy was diagnosed based on clinical presentation and ventriculography.
- Intravenous nitroglycerin initially worsened the LVOT gradient before it gradually resolved.
- The dynamic LVOT obstruction was responsive to medical management, with resolution of the gradient observed on follow-up echocardiography.
Implications:
- This case underscores the importance of considering and evaluating for dynamic LVOT obstruction in patients with TTC.
- Prompt recognition and management of TTC-related LVOT obstruction are crucial for preventing adverse cardiovascular events.
- Further research into the mechanisms and optimal treatment strategies for TTC with LVOT obstruction is warranted.
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