Dynamic Left Ventricular Outflow Tract Obstruction: A Potential Complication of Takotsubo Cardiomyopathy

Özgür Akbal, Berhan Keski̇n, Ahmet Karaduman, Seda Tanyeri̇, Ali Karagöz

Keywords: Apical ballooning, left ventricular outflow tract obstruction, Takotsubo syndrome

Abstract

Takotsubo cardiomyopathy is characterized by a clinical presentation similar to those of acute coronary syndrome and nonobstructive coronary arteries. This syndrome is triggered by physical or mental stress and is sometimes accompanied by left ventricular outflow tract (LVOT) obstruction. Takotsubo cardiomyopathy is caused by a hyperdynamic basal portion of the left ventricle. Detecting LVOT obstruction is important to initiate targeted treatment. Beta blockers and fluid resuscitation are the primary therapies used to decrease the LVOT gradient. Inotropic agents and nitrates should be avoided to prevent increasing the level of LVOT obstruction. Clinicians should keep dynamic LVOT obstruction in mind when evaluating patients with Takotsubo syndrome. Transthoracic echocardiography is an essential and practical method to diagnose this complication.