Cor Vasa 2010, 52(11-12):695-699 | DOI: 10.33678/cor.2010.174

Role of a dynamic LVOT obstruction in the pathogenesis of takotsubo syndrome

Jan Pavlovič^1,*, Karel Hlaváček¹, Rudolf Feuereisl¹, Roman Surovčík¹, Petr Frídl¹, Ondřej Myslivec², František Paďour², Pavel Jebavý¹

¹ Kardiologie na Bulovce, s. r. o., Prague

² 1st Department of Internal Medicine, University Hospital Na Bulovce, Prague, Czech Republic

Aims: To explore the possible causative relationship between a dynamic left ventricular outflow tract (LVOT) obstruction and takotsubo syndrome.

Methods and results: We analyzed a group of eleven patients with takotsubo syndrome. In this article, we focus on one patient developing a less common variant of takotsubo (stress) syndrome after a situation creating a decreased preload, but without a preceding stressful event (either psychological or physical). Coincidently we found a dynamic obstruction of left ventricular outflouw tract and septal bulge mimicking the pattern of hypertrophic cardiomyopathy. After the contraction abnormalities had normalized, we performed a provocation test with nitroglycerin on follow-up inducing the obstruction. An exercise stress test performed on follow-up showed a good effect of conservative treatment.
The relevant literature was reviewed.

Conclusion: We suggest a possible primary pathogenetic role of a dynamic LVOT obstruction in the development of takotsubo syndrome.

Keywords: Takotsubo syndrome; LVOT obstruction; Septal bulge; Hypertrophic cardiomyopathy

Published: November 1, 2010  Show citation