Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra-corporeal life support the best treatment?
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TLDR
For the first time in a Tako‐tsubo patient with refractory cardiogenic shock, the use of ECLS treatment is reported in order to unload the heart, sustain circulation and end‐organ perfusion, and promote potential ventricular recovery.Abstract:
We report the use of extra-corporeal cardiopulmonary support (ECLS), in a case of complicating refractory severe cardiogenic shock, in a patient with Tako-tsubo cardiomyopathy (TC). Tako-tsubo cardiomyopathy syndrome is characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. This ventricular dysfunction is typically reversible in the acute phase, though it can progress into refractory cardiogenic shock with limited therapeutic options available. Here, we report for the first time in a Tako-tsubo patient with refractory cardiogenic shock, the use of ECLS treatment in order to unload the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. Extra-corporeal life support allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The patient recovered completely, and a normal LV ejection fraction was documented by 2D echocardiography on day 7. From our experience, ECLS can be an appropriate treatment for severe refractory cardiogenic shock in patients with TC. Extra-corporeal life support was an effective ultimate solution.read more
Citations
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Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology
Alexander R. Lyon,Eduardo Bossone,Birke Schneider,Udo Sechtem,Rodolfo Citro,S. Richard Underwood,Mary N. Sheppard,Gemma A. Figtree,Gemma A. Figtree,Guido Parodi,Yoshihiro J. Akashi,Frank Ruschitzka,Gerasimos Filippatos,Alexandre Mebazaa,Elmir Omerovic +14 more
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Horacio Medina de Chazal,Marco Giuseppe Del Buono,Lori Keyser-Marcus,Liangsuo Ma,F. Gerard Moeller,Daniel Berrocal,Antonio Abbate +6 more
TL;DR: The proposed risk factors and triggers for the syndrome are reviewed and a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy is discussed, highlighting potential challenges and unresolved questions.
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Takotsubo syndrome: State-of-the-art review by an expert panel - Part 2
Andre Dias,Iván J. Núñez Gil,Francesco Santoro,John E. Madias,Francesco Pelliccia,Natale Daniele Brunetti,Elena Salmoirago-Blotcher,Scott W. Sharkey,Ingo Eitel,Yoshihiro J. Akashi,Ibrahim El-Battrawy,Emiliana Franco,Ibrahim Akin,Miłosz Jaguszewski,Dana Dawson,Vincent M. Figueredo,L. Christian Napp,Thomas Emil Christensen,Kathy Hebert,Itsik Ben-Dor,Yuichi Ozaki,Hector M. Garcia-Garcia,Alexandre H. Kajita,Takashi Akasaka,Satoshi Kurisu,Amir Lerman,Ron Waksman +26 more
TL;DR: Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support.
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Management of Takotsubo Syndrome: A Comprehensive Review
TL;DR: The initial management of Takotsubo syndrome includes dual antiplatelet therapy, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and statins.
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Takotsubo cardiomyopathy: pathophysiology and treatment
TL;DR: Since it was first described 20 years ago in Japan, takotsubo cardiomyopathy has received considerable interest from the medical community around the world, and a number of agents have been implicated in the acute stage and long term.
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