Acute mitral regurgitation in Takotsubo cardiomyopathy.
Takotsubo cardiomyopathy (TTC) is a well-recognised entity that commonly manifests with chest pain, ST segment abnormalities and transient left ventricular apical ballooning without coronary artery obstructive disease. This syndrome usually portends a favourable outcome. In the rare haemodynamically unstable TTC patients, acute mitral regurgitation (MR) related to systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) is to be considered. Bedside echocardiography is key in recognition of this latter condition as vasodilators, inotropic agents or intra-aortic balloon counter-pulsation worsen the patient's clinical status. We discuss here a case of TTC where nitrate-induced subaortic obstruction and mitral regurgitation led to haemodynamic instability.
Department of Cardiology, Georges Pompidou European Hospital, France nadia.bouabdallaoui@gmail.com.
Nadia
N
Bouabdallaoui
Department of Cardiology, Georges Pompidou European Hospital, France.
Zhen
Z
Wang
Department of Cardiology, Georges Pompidou European Hospital, France.
Milena
M
Lecomte
Department of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France.
Pierre V
PV
Ennezat
Department of Cardiology, Georges Pompidou European Hospital, France.
Didier
D
Blanchard
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D015415:Biomarkers; D020107:Troponin T; D014665:Vasodilator Agents
Takotsubo cardiomyopathy; left ventricular outflow tract obstruction; systolic anterior motion of the mitral valve