Hemodynamics of cardiogenic shock in a Broken Heart Syndrome patient: paradoxical effect of ionotropic agents in apical ballooning. (February 2011)

• Record Type: Journal Article
• Authors: Hussain, Jamal; Virk, Zahid; Khan, Abrar
• Is Part Of: Interventional cardiology. Volume 3:Number 1(2011)
• Page Start: 45
• Page End: 48
• Publication Date: 2011-02
• Subjects: Broken Heart Syndrome -- cardiomyopathy -- shock -- Takotsubo; Cardiology -- Periodicals; Coronary heart disease -- Treatment -- Periodicals; 616.1205
• DOI: 10.2217/ica.10.98
• Languages: English
• ISSNs: 1755-5310

Abstract

Stress-induced cardiomyopathy, also known as Broken Heart Syndrome or Takotsubo cardiomyopathy, is an increasingly recognized syndrome characterized by transient apical or midventricular dysfunction that mimics myocardial infarction in the absence of significant coronary artery disease. This disorder is much more common in women compared with men, with a mean age of 62––75 years. Different morphologic patterns of left ventricular dysfunction have been observed, with apical ballooning and hypercontracting basal segments being the most common and are observed in 60% of patients. The exact mechanism of this disorder is not well understood. Catecholamines may play an important role in the genesis of this disorder, as illustrated by a small case series demonstrating significantly increased plasma epinephrine and norepinephrine. Patients with stress-induced cardiomyopathy also tend to be prone to coronary vasospasm, induced by excess catecholamines. Typically, ionotropic agents are avoided in apical ballooning due to worsening of a left ventricular outflow tract obstruction resulting in hypotension. We report a case of cardiogenic shock due to apical ballooning, where withdrawal of ionotropic agent and the institution of an intra-aortic balloon pump allowed the recovery of hypotension and myocardial function.