title: Lesson of the month 1: broken heart in the intensive care unit.
abstract: Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. TCM can masquerade as ST elevation myocardial infarction (STEMI). TCM usually occurs following a variety of emotional stressors, but physical stressors can also trigger the condition, as highlighted by the present case. TCM can occur after an acute medical illness; therefore, physicians should be aware of this condition as a potential cause of inotrope-resistant hypotension. In patients with hypotension and moderate-to-severe left ventricular outflow tract (LVOT) obstruction, inotropic agents should be avoided, because they can worsen the degree of obstruction. Instead, beta-blockers are preferred, because they are capable of resolving the obstruction and consequently improve the haemodynamics.
authors.affiliation: Section of Cardiovascular Medicine, University of Tennessee, School of Medicine, Memphis, USA and Veterans Affairs Medical Center, Memphis, USA Shahcardiology@yahoo.com.
authors.forename: Rahman
authors.initials: R
authors.lastname: Shah
authors.affiliation: Veterans Affairs Medical Center, Memphis, USA.
authors.forename: Michela R
authors.initials: MR
authors.lastname: Shelton
authors.affiliation: Section of Cardiovascular Medicine, University of Tennessee, School of Medicine, Memphis, USA and Veterans Affairs Medical Center, Memphis, USA.
authors.forename: Kodangudi B
authors.initials: KB
authors.lastname: Ramanathan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D004562:Electrocardiography; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: ST segment elevation; Takotsubo cardiomyopathy; intensive care unit; physical stress
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