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Yastrebov K, Cranney G. Dynamic left ventricular outflow tract obstruction induced by intra-aortic balloon pump in patient with angioedema. Ultrasound J 2025; 17:22. [PMID: 40192935 PMCID: PMC11977056 DOI: 10.1186/s13089-025-00426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/14/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Intra-aortic balloon pump is used for temporary mechanical support of failing left ventricle. It works by reducing the arterial afterload during ventricular systole to reduce myocardial work and increasing diastolic proximal aortic pressure to improve coronary perfusion. Rarely, intra-aortic balloon pump (IABP) can become the cause of severe haemodynamic compromise, causing dynamic left ventricular outflow tract obstruction. CASE PRESENTATION An 88-yo man presented with angiotensin converting enzyme inhibitor (ACEI) - induced angioedema. He received steroids and adrenaline, but progressed to the respiratory arrest, requiring emergency awake fiberoptic intubation and mechanical ventilation. Echocardiography revealed catecholamine-induced reversed Takotsubo cardiomyopathy. The patient suffered asystolic cardiac arrest on arrival to intensive care unit (ICU), requiring cardiopulmonary resuscitation (CPR). Bradycardia and hypotension were treated with atrial pacing and (IABP). Icatibant was administered for angioedema. After several hours of haemodynamic stability, severe hypotension returned. Bedside echocardiographic diagnosis of recovery from Takotsubo and new development of IABP-induced dynamic left ventricular outflow tract obstruction (DLVOTO) was made. Stopping IABP resulted in rapid haemodynamic recovery. Repeated doses of Icatibant were needed. The patient survived and returned to independent living. CONCLUSIONS Immediate echocardiographic recognition of iatrogenic DLVOTO caused by IABP allows discontinuation of IABP support as a life-saving intervention. Dynamic application of spectral Doppler with changes in IABP settings is required for correct diagnosis.
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Affiliation(s)
- Konstantin Yastrebov
- University of New South Wales, Kensington, Sydney, NSW, 2033, Australia.
- Prince of Wales Hospital, Barker Street, Sydney, NSW, 2031, Australia.
- The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia.
| | - Gregory Cranney
- University of New South Wales, Kensington, Sydney, NSW, 2033, Australia
- Prince of Wales Hospital, Barker Street, Sydney, NSW, 2031, Australia
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Atanasković M, Mihajlović B, Stefanović M, Bjelobrk M, Crnomarković B, Kovačević M. Sigmoid Septum: A Bystander or Contributor to a Left Ventricular Outflow Tract Obstruction in Takotsubo Syndrome - A Case Report with a Literature Review. Intern Med 2025:4489-24. [PMID: 39993754 DOI: 10.2169/internalmedicine.4489-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2025] Open
Abstract
Approximately 20% of patients with Takotsubo syndrome (TTS) develop complications such as left ventricular outflow tract obstruction (LVOTO). The published data suggest that a significant proportion of these patients have predisposing septal hypertrophy or sigmoid septum. However, the pathophysiology regarding this connection has not yet been fully elucidated. We herein present the case of a 75-year-old female patient with TTS complicated by LVOTO, which was successfully managed. During the follow-up, mild basal septal hypertrophy was observed. Subsequent exercise and dobutamine stress echocardiography were performed to reveal the mechanism of LVOTO in TTS.
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Affiliation(s)
| | - Bojan Mihajlović
- University of Novi Sad, Faculty of Medicine, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Serbia
| | - Maja Stefanović
- University of Novi Sad, Faculty of Medicine, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Serbia
| | - Marija Bjelobrk
- University of Novi Sad, Faculty of Medicine, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Serbia
| | - Branislav Crnomarković
- University of Novi Sad, Faculty of Medicine, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Serbia
| | - Mila Kovačević
- University of Novi Sad, Faculty of Medicine, Serbia
- Institute for Cardiovascular Diseases of Vojvodina, Serbia
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Zakynthinos GE, Gialamas I, Tsolaki V, Pantelidis P, Goliopoulou A, Gounaridi MI, Tzima I, Xanthopoulos A, Kalogeras K, Siasos G, Oikonomou E. Tailored Therapies for Cardiogenic Shock in Hypertrophic Cardiomyopathy: Navigating Emerging Strategies. J Cardiovasc Dev Dis 2024; 11:401. [PMID: 39728291 DOI: 10.3390/jcdd11120401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 12/03/2024] [Accepted: 12/05/2024] [Indexed: 12/28/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder, often complicated by cardiogenic shock, a life-threatening condition marked by severe cardiac output failure. Managing cardiogenic shock in HCM patients presents unique challenges due to the distinct pathophysiology of the disease, which includes dynamic left ventricular outflow tract obstruction, diastolic dysfunction, and myocardial ischemia. This review discusses current and emerging therapeutic strategies tailored to address the complexities of HCM-associated cardiogenic shock and other diseases with similar pathophysiology that provoke left ventricular outflow tract obstruction. We explore the role of pharmacological interventions, including the use of vasopressors and inotropes, which are crucial in stabilizing hemodynamics but require careful selection to avoid exacerbating the outflow obstruction. Additionally, the review highlights advancements in mechanical circulatory support devices such as extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs), which have become vital in the acute management of cardiogenic shock. These devices provide temporary support and bridge patients to recovery, definitive therapy, or heart transplantation, which remains a critical option for those with end-stage disease. Furthermore, the review delves into the latest research and clinical trials that are refining these therapeutic approaches, ensuring they are optimized for HCM patients. The impact of these treatments on patient outcomes, including survival rates and quality of life, is also critically assessed. In conclusion, this review underscores the importance of a tailored therapeutic approach in managing cardiogenic shock in HCM patients, integrating pharmacological and mechanical support strategies to improve outcomes in this high-risk population.
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Affiliation(s)
- George E Zakynthinos
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioannis Gialamas
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41335 Larissa, Greece
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athina Goliopoulou
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Ioanna Gounaridi
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioanna Tzima
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Hussain B, Tarabanis C, Aslam MMS, Dhulipala V, Devarakonda P, Maqsood H, Moreno P. Inpatient outcomes of mechanical circulatory support devices and heart transplantation in hypertrophic cardiomyopathy. Int J Cardiol 2024; 413:132396. [PMID: 39079586 DOI: 10.1016/j.ijcard.2024.132396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/27/2024] [Accepted: 07/24/2024] [Indexed: 08/03/2024]
Abstract
INTRODUCTION The pathophysiology of HCM presents unique challenges for the management of cardiogenic shock and the use of mechanical circulatory support devices (MCSD). However, outcomes investigations for MCSD and HT in HCM patients is limited to case reports. The present study investigated MCSD and HT outcomes in HCM patients in a large retrospective cohort. METHODS The National Inpatient Sample (2016-2019) was used for the retrospective analysis of patients hospitalized for MCSD and HT using ICD-10 codes. Patients with implantation of more than one device category were excluded. These patients were divided into two cohorts, with and without HCM, and compared in terms of in-hospital mortality, trends in mortality rates, hospitalization costs and mean length of stay. RESULTS Among 267,780 patients hospitalized for MCSD and HT, 1155 patients had underlying HCM. Underlying HCM was associated with increased odds of mortality in patients receiving left ventricular assist devices (LVAD) (OR 3.4, 95% CI 1.03-11.2, p = 0.04) and temporary MCSD (OR 2.5, CI 1.8-3.6, p < 0.001). HCM was not associated with increased mortality in patients hospitalized for HT (OR 0.67, CI 0.15-2.85, p = 0.6). Patients with HCM undergoing MCSD and HT had a longer mean length of stay (22.1 vs 13.2 days, p = 0.004), and higher mean hospitalization charges ($830,103 vs $460,383, p < 0.0001) as compared to non-HCM patients. CONCLUSION Underlying HCM is associated with increased in-hospital mortality in patients undergoing LVAD and temporary MCSD placement. Further prospective studies are required to expand our understanding of prognosis among HCM patients undergoing MCSD and establish management guidelines.
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Affiliation(s)
- Bilal Hussain
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA.
| | - Constantine Tarabanis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Vishal Dhulipala
- Division of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Haisum Maqsood
- Division of Cardiovascular Medicine, Houston Methodist, Houston, TX, USA
| | - Pedro Moreno
- Division of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Citro R, Bellino M, Merli E, Di Vece D, Sherrid MV. Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning? J Am Heart Assoc 2023; 12:e032028. [PMID: 37889174 PMCID: PMC10727392 DOI: 10.1161/jaha.123.032028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
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Affiliation(s)
- Rodolfo Citro
- Cardio‐Thorax‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
- Department of Vascular PhysiopathologyIRCCS NeuromedPozzilliItaly
| | - Michele Bellino
- Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Elisa Merli
- Department of CardiologyOspedale per gli InfermiFaenzaItaly
| | - Davide Di Vece
- Department of CardiologyUniversity Hospital ZurichZurichSwitzerland
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