Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning?
Rodolfo CitroMichele BellinoElisa MerliDavide Di VeceMark V SherridPublished in: Journal of the American Heart Association (2023)
Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
Keyphrases
- hypertrophic cardiomyopathy
- left ventricular
- cardiac resynchronization therapy
- liver failure
- acute myocardial infarction
- heart failure
- drug induced
- aortic stenosis
- left atrial
- mitral valve
- respiratory failure
- case report
- early onset
- aortic dissection
- oxidative stress
- hepatitis b virus
- acute coronary syndrome
- endothelial cells
- extracorporeal membrane oxygenation
- aortic valve
- coronary artery disease
- acute respiratory distress syndrome
- percutaneous coronary intervention