title: 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.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Policlinico Universitario, Via Giustiniani, 2, 35128 Padova, Italy. federico.migliore@libero.it
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilato
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000787:Angina Pectoris; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014463:Ultrasonography; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol