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"Reverse McConnell's Sign": Interpreting Interventricular Hemodynamic Dependency and Guiding the Management of Acute Heart Failure during Takotsubo Cardiomyopathy.

Liu K, Sun Z, Wei T - Clin Med Insights Cardiol (2015)

Bottom Line: Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences.Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise.Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY.

ABSTRACT
Although most patients with Takotsubo cardiomyopathy (TTC) have benign clinical course and prognosis, TTC can induce acute heart failure and hemodynamic instability. TTC mimics the clinical features of acute anterior wall myocardial infarction (AMI). Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences. Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise. Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC. We review recent advances in echocardiographic diagnosis of TTC and its role in guiding bedside management of acute heart failure and cardiogenic shock, with specific focus on the interpretation of discrepant, but reciprocally dependent, left and right ventricular hemodynamics during acute stages of TTC.

No MeSH data available.


Related in: MedlinePlus

Distinctive distribution patterns of left ventricular (LV) wall motion abnormality in two-dimensional (2D) (A, B, E, and F) and three-dimensional (3D) (C, D, G, and H) echocardiography images in patients with anterior ST segment elevation myocardial infarction (AMI) and Takotsubo cardiomyopathy (TTC).Notes: Left panels: AMI; right panels: TTC.
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f1-cmc-suppl.1-2015-033: Distinctive distribution patterns of left ventricular (LV) wall motion abnormality in two-dimensional (2D) (A, B, E, and F) and three-dimensional (3D) (C, D, G, and H) echocardiography images in patients with anterior ST segment elevation myocardial infarction (AMI) and Takotsubo cardiomyopathy (TTC).Notes: Left panels: AMI; right panels: TTC.

Mentions: Compared with patients with AMI, those with TTC usually have higher LV volumes (both systolic and diastolic) and worse systolic function (lower LV ejection fraction). Quantitative wall motion abnormalities in those with TTC, measured by the wall motion score index, are more prominent than those with AMI.13 With two-dimensional (2D) echocardiography, although similar “apical ballooning” is sometimes observed in both AMI (Fig. 1A: in diastole; Fig. 1B: in systole) and TTC (Fig. 1E: in diastole; Fig. 1F: in systole), the distinctive segmental wall motion patterns can help us differentiate between TTC and AMI. In contrast with AMI, TTC typically results in a hypocontractile (or akinetic) apical wall, but hypercontractile basilar walls, and its abnormal anatomic distribution is not confined to any single coronary artery territory (Movie Clips 1 and 2). These imaging features can be better characterized with three-dimensional (3D) and strain echocardiography techniques.


"Reverse McConnell's Sign": Interpreting Interventricular Hemodynamic Dependency and Guiding the Management of Acute Heart Failure during Takotsubo Cardiomyopathy.

Liu K, Sun Z, Wei T - Clin Med Insights Cardiol (2015)

Distinctive distribution patterns of left ventricular (LV) wall motion abnormality in two-dimensional (2D) (A, B, E, and F) and three-dimensional (3D) (C, D, G, and H) echocardiography images in patients with anterior ST segment elevation myocardial infarction (AMI) and Takotsubo cardiomyopathy (TTC).Notes: Left panels: AMI; right panels: TTC.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4373721&req=5

f1-cmc-suppl.1-2015-033: Distinctive distribution patterns of left ventricular (LV) wall motion abnormality in two-dimensional (2D) (A, B, E, and F) and three-dimensional (3D) (C, D, G, and H) echocardiography images in patients with anterior ST segment elevation myocardial infarction (AMI) and Takotsubo cardiomyopathy (TTC).Notes: Left panels: AMI; right panels: TTC.
Mentions: Compared with patients with AMI, those with TTC usually have higher LV volumes (both systolic and diastolic) and worse systolic function (lower LV ejection fraction). Quantitative wall motion abnormalities in those with TTC, measured by the wall motion score index, are more prominent than those with AMI.13 With two-dimensional (2D) echocardiography, although similar “apical ballooning” is sometimes observed in both AMI (Fig. 1A: in diastole; Fig. 1B: in systole) and TTC (Fig. 1E: in diastole; Fig. 1F: in systole), the distinctive segmental wall motion patterns can help us differentiate between TTC and AMI. In contrast with AMI, TTC typically results in a hypocontractile (or akinetic) apical wall, but hypercontractile basilar walls, and its abnormal anatomic distribution is not confined to any single coronary artery territory (Movie Clips 1 and 2). These imaging features can be better characterized with three-dimensional (3D) and strain echocardiography techniques.

Bottom Line: Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences.Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise.Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY.

ABSTRACT
Although most patients with Takotsubo cardiomyopathy (TTC) have benign clinical course and prognosis, TTC can induce acute heart failure and hemodynamic instability. TTC mimics the clinical features of acute anterior wall myocardial infarction (AMI). Bedside clinicians often have a diagnostic dilemma when cardiac catheterization and angiography are either contraindicated or can cause potential adverse consequences. Misdiagnosing TTC as AMI will lead to initiation of harmful pharmacological or device-based treatment, which worsens hemodynamic compromise. Therefore, understanding and interpreting the unique pathophysiological and hemodynamic features of TTC in a better manner becomes crucial to guide effective clinical management of acute heart failure/cardiogenic shock during TTC. We review recent advances in echocardiographic diagnosis of TTC and its role in guiding bedside management of acute heart failure and cardiogenic shock, with specific focus on the interpretation of discrepant, but reciprocally dependent, left and right ventricular hemodynamics during acute stages of TTC.

No MeSH data available.


Related in: MedlinePlus