use alpha pressors for takotsubo cardiomyopathy

The patient has a dilated left ventricular apex with hypokinesis of the apex (apical ballooning pattern), with normal movement at the left ventricular base. This is the classic pattern of a stress cardiomyopathy. Stress-induced cardiac dysfunction is frequently seen as a complication of acute stress states. Most of these patients will have a mildly elevated troponin. The underlying etiology is likely the release of catecholamines. The treatment is supportive care and resolution of the underlying stressor. Care should be taken to avoid volume depletion because this may lead to a left ventricular outflow tract obstruction. Avoidance of catecholamines unless needed is also recommended, and if support of hypotension is needed, α-agonists are preferred. Acute anterior wall myocardial infarction would likely produce segmental motion abnormalities on echocardiography (choice A is incorrect). This is an important point, and this entity should always be distinguished from a stress cardiomyopathy because the treatment is very different. A dilated cardiomyopathy would show decreased function of the entire left ventricle and usually would not have this pattern of preservation of the base (Video 3) (choice B is incorrect). Pericardial tamponade is incorrect because you would expect fluid around the heart in the pericardial space to be compressing the right atrium and ventricle (choice D is incorrect).1

Footnotes

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