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Takotsubo Complications — EECC MCQ

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ModerateCardiomyopathyTakotsubo ComplicationsEECC

A 55-year-old woman with suspected Takotsubo syndrome (apical ballooning, mild troponin rise, emotional trigger) is admitted to CCU. She is haemodynamically stable. What complication should be specifically monitored for?

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Correct answer: D — Dynamic LVOT obstruction due to basal hyperkinesis and apical akinesis creating a Venturi effect, which can cause acute haemodynamic deterioration — avoid inotropes and volume depletion

Takotsubo syndrome (TTS) can cause several acute complications: (1) dynamic LVOT obstruction (occurs in ~10-25% due to basal hyperkinesis with apical ballooning creating SAM of the mitral valve and Venturi effect — similar physiology to obstructive HCM; treatment with inotropes or vasodilators worsens obstruction); (2) acute MR (from SAM or papillary muscle dysfunction); (3) cardiogenic shock (in ~5-10%); (4) ventricular arrhythmias and QTc prolongation; (5) LV thrombus (in the akinetic apex); (6) LV free wall rupture (rare). The 2023 ESC Cardiomyopathy Guidelines recommend CCU monitoring, echo for LVOT gradient assessment, avoidance of catecholamines and inotropes, and anticoagulation consideration if severe apical akinesis.

Reference: ESC (2023): Guidelines on Cardiomyopathies