Striking observations during emergency catecholamine treatment of cardiac syncope in a patient with initially unrecognized takotsubo cardiomyopathy.

Abstract

A case is presented of initially unrecognized takotsubo cardiomyopathy with a dramatic clinical course after emergency catecholamine treatment for circulatory support during stress-induced cardiac syncope followed by complete recovery of cardiac function after catecholamine withdrawal and starting beta-blocker therapy. Echocardiography including 2D-strain imaging suggested that the left ventricle (LV) wall motion abnormality was mainly the consequence of geometry-induced regional differences in wall stress (progressively amplified by catecholamines), which might be another possible pathophysiological mechanism involved in the development of LV dysfunction in takotsubo cardiomyopathy. This case also suggests that in emergency, before coronary angiography is possible, echocardiography can be helpful for initial therapeutic decisions, especially to avoid emergency inotropic therapy in such patients.

• Authors: Michael Dandel, Hans B Lehmkuhl, Gunther Schmidt, Christoph Knosalla, Roland Hetzer
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 73 Issue 8 Pg. 1543-6 (Aug 2009) ISSN: 1347-4820 [Electronic] Japan
• PMID: 19139593 (Publication Type: Case Reports, Journal Article)

Chemical References

• Catecholamines

Topics

• Aged
• Catecholamines (therapeutic use)
• Electrocardiography
• Emergency Treatment
• Female
• Humans
• Recovery of Function
• Syncope (drug therapy, etiology)
• Takotsubo Cardiomyopathy (diagnosis, drug therapy)