title: Biventricular takotsubo cardiomyopathy: case study and review of literature.
abstract: Biventricular takotsubo cardiomyopathy is associated with more hemodynamic instability than is isolated left ventricular takotsubo cardiomyopathy; medical management is more invasive and the course of hospitalization is longer. In March 2011, a 62-year-old woman presented at our emergency department with abdominal pain, nausea, and vomiting. On hospital day 2, she experienced chest pain. An electrocardiogram and cardiac enzyme levels suggested an acute myocardial infarction. She underwent cardiac angiography and was found to have severe left ventricular systolic dysfunction involving the mid and apical segments, which resulted in a left ventricular ejection fraction of 0.10 to 0.15 in the absence of obstructive coronary artery disease. Her hospital course was complicated by cardiogenic shock that required hemodynamic support with an intra-aortic balloon pump and dobutamine. A transthoracic echocardiogram revealed akinesis of the mid-to-distal segments of the left ventricle and mid-to-apical dyskinesis of the right ventricular free wall characteristic of biventricular takotsubo cardiomyopathy. After several days of medical management, the patient was discharged from the hospital in stable condition. To the best of our knowledge, this is the first review of the literature on biventricular takotsubo cardiomyopathy that compares its hemodynamic instability and medical management requirements with those of isolated left ventricular takotsubo cardiomyopathy. Herein, we discuss the case of our patient, review the pertinent medical literature, and convey the prevalence and importance of right ventricular involvement in patients with takotsubo cardiomyopathy.
authors.affiliation: Department of Cardiology, Memorial Hospital, 325 S. Belmont St., York, Pennsylvania 17405, USA. jdaoko@mhyork.org
authors.forename: Joseph
authors.initials: J
authors.lastname: Daoko
authors.forename: Manu
authors.initials: M
authors.lastname: Rajachandran
authors.forename: Ronald
authors.initials: R
authors.lastname: Savarese
authors.forename: Joseph
authors.initials: J
authors.lastname: Orme
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects
chemical_list: D002317:Cardiovascular Agents
keywords: Cardiomyopathies/radiography; hemodynamic instability/takotsubo; magnetic resonance angiography; takotsubo cardiomyopathy, biventricular/diagnosis; transient apical ballooning syndrome; ventricular dysfunction, left; ventricular dysfunction, right
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