title: Tako-Tsubo cardiomyopathy presenting with cardiogenic shock successfully treated with milrinone: a case report.
abstract: We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without coronary lesions suggested TTC. Within a few hours milrinone infusion normalized the cardiac index. TTC is responsible for severe transient left ventricular dysfunction occurring after physical or psychological stress. The major pathophysiological mechanism involved is disproportionate catecholamine secretion, which may stun the myocardium. We considered if treatment of this unique physiopathology with catecholamines could be dangerous in these patients and if alternative inotropes such as milrinone should be preferred.
authors.affiliation: Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France. Electronic address: doyen.d@chu-nice.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Doyen
authors.affiliation: Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dellamonica
authors.affiliation: Department of Cardiology, Pasteur University Hospital, 30 Avenue de la Voie Romaine, 06002 Nice, France.
authors.forename: Pamela
authors.initials: P
authors.lastname: Moceri
authors.affiliation: Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Moschietto
authors.affiliation: Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Hyvernat
authors.affiliation: Department of Cardiology, Pasteur University Hospital, 30 Avenue de la Voie Romaine, 06002 Nice, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Ferrari
authors.affiliation: Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200 Nice, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bernardin
mesh_terms: D000435:Alcoholic Intoxication / Q000150:complications; D001569:Benzodiazepines / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000209:etiology; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000188:drug therapy*
chemical_list: D002316:Cardiotonic Agents; D001569:Benzodiazepines; D020105:Milrinone
keywords: Calcium sensitizer; Cardiogenic shock; Catecholamine; Milrinone; Tako-Tsubo cardiomyopathy