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• W2893971031 abstract "We were interested in the case report of Nalluri et al.1Nalluri N. Asti D. Anugu V.R. Ibrahim U. Lafferty J.C. Olkovsky Y. Cardiogenic shock secondary to takotsubo cardiomyopathy in a patient with preexisting hypertrophic obstructive cardiomyopathy.Cardiovasc Imaging Case Reports. 2018; 2: 78-81Google Scholar We would like to draw the authors' attention to our report of two patients with hypertrophic cardiomyopathy with known latent obstruction who developed apical ballooning and cardiogenic shock when obstruction became severe and unrelenting.2Sherrid M.V. Balaran S.K. Korzeniecki E. Chaudhry F.A. Swistel D.G. Reversal of acute systolic dysfunction and cardiogenic shock in hypertrophic cardiomyopathy by surgical relief of obstruction.Echocardiography. 2011; 28: E174-E179Crossref PubMed Scopus (12) Google Scholar These two patients had shock that was unresolved by intravenous administration of copious fluids, β-blockade, and phenylephrine. Finally, both patients were taken to the operating room in extremis for relief of left ventricular (LV) outflow tract obstruction. Remarkably, in both cases apical ballooning and shock resolved almost immediately after cardiopulmonary bypass. Both patients are alive with normal LV function 10 and 7 years later. We advanced an explanation for the observed LV dysfunction on the basis of prior research.2Sherrid M.V. Balaran S.K. Korzeniecki E. Chaudhry F.A. Swistel D.G. Reversal of acute systolic dysfunction and cardiogenic shock in hypertrophic cardiomyopathy by surgical relief of obstruction.Echocardiography. 2011; 28: E174-E179Crossref PubMed Scopus (12) Google Scholar, 3Sherrid M.V. Gunsburg D.Z. Pearle G. Mid-systolic drop in left ventricular ejection velocity in obstructive hypertrophic cardiomyopathy.J Am Soc Echocardiogr. 1997; 10: 707-712Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 4Barac I. Upadya S. Pilchik R. Winson G. Passick M. Chaudhry F.A. et al.Effect of obstruction on longitudinal left ventricular shortening in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2007; 49: 1203-1211Crossref PubMed Scopus (26) Google Scholar, 5Sherrid M.V. Wever-Pinzon O. Shah A. Chaudhry F.A. Reflections of inflections in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2009; 54: 212-219Crossref PubMed Scopus (46) Google Scholar Milder degrees of systolic dysfunction are common in obstructive hypertrophic cardiomyopathy, even when the ejection fraction is normal. In the presence of significant LV outflow gradients, a midsystolic drop in LV Doppler ejection velocities and flow is observed at the entrance of the outflow tract. This has been termed the “lobster claw abnormality” because of its characteristic bifid appearance.3Sherrid M.V. Gunsburg D.Z. Pearle G. Mid-systolic drop in left ventricular ejection velocity in obstructive hypertrophic cardiomyopathy.J Am Soc Echocardiogr. 1997; 10: 707-712Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar It is caused by an abrupt decline of LV longitudinal shortening due to afterload-mismatch.4Barac I. Upadya S. Pilchik R. Winson G. Passick M. Chaudhry F.A. et al.Effect of obstruction on longitudinal left ventricular shortening in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2007; 49: 1203-1211Crossref PubMed Scopus (26) Google Scholar It is compelling evidence of the deleterious mechanical effect of obstruction. Both the abrupt decline of longitudinal systolic shortening and the midsystolic drop in ejection velocities are reversed by relief of obstruction.4Barac I. Upadya S. Pilchik R. Winson G. Passick M. Chaudhry F.A. et al.Effect of obstruction on longitudinal left ventricular shortening in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2007; 49: 1203-1211Crossref PubMed Scopus (26) Google Scholar Ischemia and myocyte energy depletion contribute to LV systolic dysfunction. We posit that our patients' shock was a more severe manifestation of these same phenomena. Could this be takotsubo cardiomyopathy caused by a neurohumoral mechanism? Prompt recovery within minutes of removal of afterload makes this unlikely. Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy in a Patient with Preexisting Hypertrophic Obstructive CardiomyopathyCASEVol. 2Issue 3PreviewTakotsubo cardiomyopathy (TCM) is a condition that leads to transient left ventricular (LV) dysfunction. Hypotension in a patient with TCM should be carefully evaluated for LV outflow tract obstruction (LVOTO) with an echocardiogram. Here we present a case of TCM in a patient with known LVOTO secondary to hypertrophic obstructive cardiomyopathy (HOCM). Full-Text PDF Open Access" @default.
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• W2893971031 date "2018-12-01" @default.
• W2893971031 modified "2023-10-17" @default.
• W2893971031 title "Apical Ballooning and Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy" @default.
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• W2893971031 doi "https://doi.org/10.1016/j.case.2018.07.009" @default.
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