A 64-Year-Old Woman With Extremity Swelling and Cough

Francisco Aguilar, MD; Carla Arellano Pizano, MD


July 17, 2018

Treatment of Takotsubo cardiomyopathy is supportive and conservative. Removal of the stressor often leads to an improvement of the symptoms and recovery of the ejection fraction. Special attention is required in cases where complications develop, because treatment must be tailored according to the initial presentation and clinical findings.

In cases that include hypotension and shock, left ventricular outflow tract (LVOT) obstruction must be assessed by imaging. If LVOT obstruction is present, the management is similar to hypertrophic obstructive cardiomyopathy; volume resuscitation and beta-blockers are preferred. In the absence of LVOT obstruction, positive inotropics and vasopressors are the best choices. Anticoagulation with vitamin K antagonists to prevent the formation of an intracavitary thrombus is recommended only for cases in which the bleeding risk is low. It is also recommended for patients with a left ventricular thrombus to prevent embolization.

Patients with Takotsubo cardiomyopathy generally have a good prognosis. Although in-hospital mortality is low compared with that of patients who have acute coronary syndrome (around 1%), risk for in-hospital complication is similar between the two groups.[2,6] Left ventricular apical ballooning may recur, but is uncommon. Recovery of the ventricular ejection fraction typically occurs within days to weeks, with an average of 18 days.[6]

The patient in this case was managed with diuresis and supportive treatment. Her gastrointestinal symptoms resolved after 2 days. Her shortness of breath improved over 5 days. Given the resolution of her symptoms, she was discharged home. She attended a follow-up appointment in the cardiology outpatient clinic 1 month after discharge. Studies performed at that time revealed a left ventricular ejection fraction of 55%. No wall motion abnormalities or diastolic dysfunction were observed.


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