Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy

Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy 2118 Cardiovascular flashlight doi:10.1093/eurheartj/ehx812 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 16 January 2018 .................................................................................................................................................... Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy 1 2 1 1 2 1,2 Hideto Sangen *, Yoichi Imori , Shuhei Tara , Takeshi Yamamoto , Hitoshi Takano , and Wataru Shimizu 1 2 Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan; and Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan * Corresponding author. Tel: +81 3 3822 2131, Fax: +81 3 5685 0987, Email: sangen777@nms.ac.jp Approximately 10% of patients with takotsubo cardiomyopathy (TC) develop cardiogenic shock (CS). Although intra-aortic balloon pump- ing (IABP) is widely used in patients with CS, application of IABP in patients with TC sometimes worsens haemodynamics when it is compli- cated by a left ventricular outflow tract obstruction (LVOTO). Here, we report on haemodynamic deterioration caused by the introduction of an IABP, which also increased the pressure gradient be- tween the aorta and left ventricle (LV), when it was applied in a patient with TC and LVOTO. Twelve-lead electrocardiography—an electro- cardiogram showed ST-segment elevation from leads II, III, aVf, and V2–V6 (Panel A). Coronary angiography (CAG), left ventriculography (LVG), and simultaneous dual-catheter pressure waveforms in the aorta and LV—CAG and LVG revealed no significant obstructive coron- ary artery disease and left ventricular apical ballooning (Panel B). Simultaneous dual-catheter pressure waveforms showed a pressure gradient (70 mmHg) between the aorta and LV. Effect of IABP on haemodynamics—an IABP supports a markedly worsened pressure gradient (70!120 mmHg) between the aorta and LV and decreased systemic mean blood pressure (94!63 mmHg) (Panel C). Haemodynamic effect of propranolol—after interrupting IABP, propranolol (2 mg) was administered intravenously, which improved the pressure gradient (70!30 mmHg) and systemic mean blood pressure (94!116 mmHg) (Panel D). V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/22/2118/4812642 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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1522-9645
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10.1093/eurheartj/ehx812
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Abstract

2118 Cardiovascular flashlight doi:10.1093/eurheartj/ehx812 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 16 January 2018 .................................................................................................................................................... Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy 1 2 1 1 2 1,2 Hideto Sangen *, Yoichi Imori , Shuhei Tara , Takeshi Yamamoto , Hitoshi Takano , and Wataru Shimizu 1 2 Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan; and Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan * Corresponding author. Tel: +81 3 3822 2131, Fax: +81 3 5685 0987, Email: sangen777@nms.ac.jp Approximately 10% of patients with takotsubo cardiomyopathy (TC) develop cardiogenic shock (CS). Although intra-aortic balloon pump- ing (IABP) is widely used in patients with CS, application of IABP in patients with TC sometimes worsens haemodynamics when it is compli- cated by a left ventricular outflow tract obstruction (LVOTO). Here, we report on haemodynamic deterioration caused by the introduction of an IABP, which also increased the pressure gradient be- tween the aorta and left ventricle (LV), when it was applied in a patient with TC and LVOTO. Twelve-lead electrocardiography—an electro- cardiogram showed ST-segment elevation from leads II, III, aVf, and V2–V6 (Panel A). Coronary angiography (CAG), left ventriculography (LVG), and simultaneous dual-catheter pressure waveforms in the aorta and LV—CAG and LVG revealed no significant obstructive coron- ary artery disease and left ventricular apical ballooning (Panel B). Simultaneous dual-catheter pressure waveforms showed a pressure gradient (70 mmHg) between the aorta and LV. Effect of IABP on haemodynamics—an IABP supports a markedly worsened pressure gradient (70!120 mmHg) between the aorta and LV and decreased systemic mean blood pressure (94!63 mmHg) (Panel C). Haemodynamic effect of propranolol—after interrupting IABP, propranolol (2 mg) was administered intravenously, which improved the pressure gradient (70!30 mmHg) and systemic mean blood pressure (94!116 mmHg) (Panel D). V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/22/2118/4812642 by Ed 'DeepDyve' Gillespie user on 21 June 2018

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European Heart JournalOxford University Press

Published: Jan 16, 2018

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