Haemodynamic effects of acute intravenous metoprolol in apical ballooning syndrome with dynamic left ventricular outflow tract obstruction.

Abstract

Takotsubo syndrome, also called apical ballooning syndrome, is a clinical entity characterized by transient hypokinesis, akinesis, or dyskinesis of the left ventricular mid-segments with or without apical involvement, and without obstructive coronary lesions. The contemporary presence of left ventricular outflow tract obstruction (LVOTO), systolic anterior motion of the anterior mitral leaflet, and acute mitral regurgitation might explain the worsening of the heart failure or the occurrence of cardiogenic shock in some patients with apical ballooning syndrome. The use of beta-blockers should improve the LVOTO gradient by reducing basal hypercontractility, increasing left ventricular filling and size, and reducing heart rate. However, clear evidence of the direct haemodynamic effects of beta-blockers is still lacking. We present a case of apical ballooning syndrome complicated by dynamic LVOTO, treated with metoprolol.

• Authors: Federico Migliore, Claudio Bilato, Gianbattista Isabella, Sabino Iliceto, Giuseppe Tarantini
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 12 Issue 3 Pg. 305-8 (Mar 2010) ISSN: 1879-0844 [Electronic] England
• PMID: 20097684 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Metoprolol

Topics

• Adrenergic beta-Antagonists (administration & dosage, therapeutic use)
• Angina Pectoris
• Female
• Heart Ventricles (diagnostic imaging, pathology)
• Hemodynamics (drug effects)
• Humans
• Injections, Intravenous
• Metoprolol (administration & dosage, therapeutic use)
• Middle Aged
• Mitral Valve Insufficiency (physiopathology)
• Takotsubo Cardiomyopathy (complications, diagnostic imaging, drug therapy)
• Ultrasonography
• Ventricular Outflow Obstruction (complications, diagnostic imaging, drug therapy, physiopathology)