Cargando…

Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone

Takotsubo cardiomyopathy (TTC) was initially reported in the 1990s as a reversible cause of cardiomyopathy induced by acute emotional stress. It is characterized by regional systolic dysfunction in the absence of coronary artery disease. We report a case of a 79-year-old woman who was admitted with...

Descripción completa

Detalles Bibliográficos
Autores principales: Pahuja, Karan H, Wasef, Natale, Hasan, Syed, Fatima, Tehreem, Hamilton, Steven, Seelagy, Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9452049/
https://www.ncbi.nlm.nih.gov/pubmed/36106204
http://dx.doi.org/10.7759/cureus.27820
_version_ 1784784858444201984
author Pahuja, Karan H
Wasef, Natale
Hasan, Syed
Fatima, Tehreem
Hamilton, Steven
Seelagy, Marc
author_facet Pahuja, Karan H
Wasef, Natale
Hasan, Syed
Fatima, Tehreem
Hamilton, Steven
Seelagy, Marc
author_sort Pahuja, Karan H
collection PubMed
description Takotsubo cardiomyopathy (TTC) was initially reported in the 1990s as a reversible cause of cardiomyopathy induced by acute emotional stress. It is characterized by regional systolic dysfunction in the absence of coronary artery disease. We report a case of a 79-year-old woman who was admitted with acute respiratory failure due to pneumonia and was found to have a troponin elevation. Upon further evaluation, the patient was taken to the cardiac catheterization lab and underwent catheterization which showed apical ballooning concerning Takotsubo cardiomyopathy. She was placed on a norepinephrine drip but remained unstable. Milrinone-facilitated diuresis was then initiated with improvement and stabilization in hemodynamics. Takotsubo cardiomyopathy presenting with cardiogenic shock without left ventricular outflow tract obstruction requires treatment with inotropes. Although there is limited data to support the use of milrinone in cardiogenic shock due to TTC, its use in our case facilitated diuresis and improved the patient’s outcome after norepinephrine failed to stabilize our patient’s hemodynamics. Milrinone inhibits phosphodiesterase type 3 which increases the calcium influx thereby improving the myocardial contraction without any beta agonist action. Therefore, the use of milrinone which is a non-catecholamine inotrope could be considered a better alternative as compared to dobutamine given the underlying pathophysiology of TTC.
format Online
Article
Text
id pubmed-9452049
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-94520492022-09-13 Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone Pahuja, Karan H Wasef, Natale Hasan, Syed Fatima, Tehreem Hamilton, Steven Seelagy, Marc Cureus Cardiology Takotsubo cardiomyopathy (TTC) was initially reported in the 1990s as a reversible cause of cardiomyopathy induced by acute emotional stress. It is characterized by regional systolic dysfunction in the absence of coronary artery disease. We report a case of a 79-year-old woman who was admitted with acute respiratory failure due to pneumonia and was found to have a troponin elevation. Upon further evaluation, the patient was taken to the cardiac catheterization lab and underwent catheterization which showed apical ballooning concerning Takotsubo cardiomyopathy. She was placed on a norepinephrine drip but remained unstable. Milrinone-facilitated diuresis was then initiated with improvement and stabilization in hemodynamics. Takotsubo cardiomyopathy presenting with cardiogenic shock without left ventricular outflow tract obstruction requires treatment with inotropes. Although there is limited data to support the use of milrinone in cardiogenic shock due to TTC, its use in our case facilitated diuresis and improved the patient’s outcome after norepinephrine failed to stabilize our patient’s hemodynamics. Milrinone inhibits phosphodiesterase type 3 which increases the calcium influx thereby improving the myocardial contraction without any beta agonist action. Therefore, the use of milrinone which is a non-catecholamine inotrope could be considered a better alternative as compared to dobutamine given the underlying pathophysiology of TTC. Cureus 2022-08-09 /pmc/articles/PMC9452049/ /pubmed/36106204 http://dx.doi.org/10.7759/cureus.27820 Text en Copyright © 2022, Pahuja et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Pahuja, Karan H
Wasef, Natale
Hasan, Syed
Fatima, Tehreem
Hamilton, Steven
Seelagy, Marc
Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title_full Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title_fullStr Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title_full_unstemmed Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title_short Successful Management of Hemodynamically Unstable Takotsubo Cardiomyopathy With Milrinone
title_sort successful management of hemodynamically unstable takotsubo cardiomyopathy with milrinone
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9452049/
https://www.ncbi.nlm.nih.gov/pubmed/36106204
http://dx.doi.org/10.7759/cureus.27820
work_keys_str_mv AT pahujakaranh successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone
AT wasefnatale successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone
AT hasansyed successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone
AT fatimatehreem successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone
AT hamiltonsteven successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone
AT seelagymarc successfulmanagementofhemodynamicallyunstabletakotsubocardiomyopathywithmilrinone