Takosubo Cardiomyopathy

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

239

Pages:

4
Author:

Mariam A. A.

Takosubo Cardiomyopathy Definition Acute stress (emotional or physical) left LV dysfunction Key Info Reversible Can mimic acute coronary syndrome Epidemiology The vast majority of cases are post-menopausal women More common in patients with mental health illness Causes Intense emotional stress Usually negative emotions Rarely positive emotions Severe illness Drugs Pathophysiology Trigger SNS activation catecholamine surge cardiotoxicity, mutlvessel spams and dysfunction myocardial stunning Clinical Features May overlap with ACS Retrosternal chest pain with angina features Dyspnoea Syncope Arrythmias Features of HF and/or cardiogenic shock Investigations Labs Elevated troponin T and I Elevated Creatinine kinase MB Elevated BNP ECG Abnormal in most patients Ischemic changes ST elevations Most common Usually in precordial leads ST depression Diffuse T wave inversion Prolonged QT TTE For all patients Findings: Decreased LVEF Reginal wall abnormalities Apical LV ballooning Global LV dyskinesis most commonly apex LVOT obstruction Coronary angiography To exclude ACS Cardiac MRI To exclude DDx Findings similar to TTE CT angiography Alternative for patients in whom MRI is contradicted DDx ACS Acute myocarditis Cardiomyopathies Management Haemodynamically stable Manage as HF Haemodynamically unstable LVOT obstruction not present LVOT obstruction present IV fluids Improve LV systolic dysfunction Low dose BB Inotropic meds Relieves LVOT Levosinmendan – preferred Vasopressors if there is shock Dobutamine and dopamine Advanced therapies can be used but can cause tachycardia and worsen takotsubo cardiomyopathy LV assist device Vasopressors ECMO If above not enough Avoid: Advanced Inotropes IABP Vasodilators LV assist device NTG ECMO Diuretics IABP Additional ACS management Until ACS is excluded VTE prophylaxis Identify and manage underlying cause Prevention Avoid triggers Chronic BBs and/or RAAS therapy Complications Acute HF accompanied by pulmonary oedema Most common Cardiogenic shock Ventricular tachyarrthyrmias Mortality