Takotsubo cardiomyopathy with LVOT obstruction in a case of STEMI: a rare cause of peri-PCI hypotension

• Published in: BMJ case reports Vol. 14; no. 1; p. e236171
• Main Authors: Fatima, Shumail, Romeo, Jared, Pacella, John
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 28.01.2021; BMJ Publishing Group
• Subjects: Acute coronary syndromes; Adrenergic beta-Antagonists - therapeutic use; Blood clots; Blood pressure; Cardiomyopathy; Cardiotonic Agents - adverse effects; Cardiovascular disease; Case Report; Case reports; Coronary Angiography; Coronary vessels; Dopamine; Drug-Eluting Stents; Dyspnea; Echocardiography; Female; Heart attacks; Heart failure; Heart rate; Heart Ventricles; Humans; Hypotension; Hypotension - drug therapy; Hypotension - etiology; Intraoperative Complications - drug therapy; Intraoperative Complications - etiology; Laboratories; Medical diagnosis; Medical imaging; Middle Aged; Pain; Patients; Percutaneous Coronary Intervention; Phenylephrine - therapeutic use; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Pulmonary arteries; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - surgery; Takotsubo Cardiomyopathy - complications; Takotsubo Cardiomyopathy - diagnostic imaging; Thrombectomy; Thrombosis; Ultrasonic imaging; Vasoconstrictor Agents - therapeutic use; Ventricular Outflow Obstruction - complications; Ventricular Outflow Obstruction - diagnostic imaging; Vital signs; heart failure; interventional cardiology; clinical diagnostic tests
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-236171

Takotsubo cardiomyopathy (TCM) associated with left ventricular outflow tract (LVOT) obstruction in the event of an ST-elevation myocardial infarction (STEMI) is a rare cause of hypotension during percutaneous coronary intervention (PCI). Herein, we describe a 57-year-old woman who presented with STEMI and underwent PCI. She developed hypotension which worsened during inotropic therapy. Echocardiography revealed evidence of LVOT obstruction in the setting of TCM. Therefore, inotropic support was promptly discontinued. Beta blockers and phenylephrine were rapidly administrated, resulting in improved blood pressure and stabilisation of the patient.