title: "Reverse McConnell's Sign": Interpreting Interventricular Hemodynamic Dependency and Guiding the Management of Acute Heart Failure during Takotsubo Cardiomyopathy.
abstract: Although most patients with Takotsubo cardiomyopathy (TTC) have benign clinical course and prognosis, TTC can induce acute heart failure and hemodynamic instability. TTC mimics the clinical features of acute anterior wall myocardial infarction (AMI). Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences. Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise. Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC. We review recent advances in echocardiographic diagnosis of TTC and its role in guiding bedside management of acute heart failure and cardiogenic shock, with specific focus on the interpretation of discrepant, but reciprocally dependent, left and right ventricular hemodynamics during acute stages of TTC.
authors: Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY.
authors: Kan
authors: K
authors: Liu
authors: Department of Cardiology, Lishui Central Hospital, Zhejiang University, Zhejiang, People's Republic of China.
authors: Zhongxia
authors: Z
authors: Sun
authors: Department of Cardiology, Lishui Central Hospital, Zhejiang University, Zhejiang, People's Republic of China.
authors: Tiemin
authors: T
authors: Wei
keywords: Takotsubo cardiomyopathy; acute heart failure; cardiogenic shock; interventricular dependency; reverse McConnell’s sign