Left ventricular ballooning syndrome

Drug withdrawal Transient left ventricular ballooning syndrome (takotsubo cardiomyopathy) occurs mostly in post-menopausal women in response to stressful events and beta-blockers are used to treat it. Abrupt withdrawal of beta-blockade can result in a hyperadrenergic syndrome that can lead to takotsubo cardiomyopathy, even in the absence of a stressful precipitating event [14 ]. 

Transient left-ventricular apical ballooning (Tako-Tsubo syndrome)... 

Previtali M, Repetto A, Scuteri L. Dobutamine induced severe midventricular obstruction and mitral regurgitation in left ventricular apical ballooning syndrome. Heart 2005 91(3) 353. 

Cardiovascular Tako-Tsubo syndrome is transient left ventricular apical ballooning, very similar to acute myocardial infarction. 

Indirect effects of drugs on catecholamines have ako resulted in takotsubo syndrome. In one case there was transient typical ballooning of the left ventricular apex during systole following the use of cocaine, thought to have been due to inhibition of catecholamine reuptake [22ft]. A 43-year-old woman who took an overdose of venlafaxine, an inhibitor of serotonin and noradrenaline reuptake, developed a takotsubo cardiomyopathy and there was an increase in urinary normetadrenaline (normetanephrine) concentration [23 ]. 

Catecholamines do not improve function in the apical ballooning syndrome and may make it worse. In 11 patients cm infusion of low-dose dobutamine did not improve the akinetic wcdl motion, despite the hypercontractile basal left ventricular wcdl, and despite the fact that the syndrome is reversible [29 ]. In other cases, takotsubo syndrome was worsened by infusion of catecholamines (in one case adrenaline, dobutamine, and noradrenaline and in another dopamine) and improved when the catecholamines were withdrawn [30, 31 ] beta-blockade was beneficial... 

Fujiwara S, Takeishi Y, Isoyama S, Aono G, Takizawa K, Honda H, Otomo T, Mitsuoka M, Itoh Y, Terashima M, Kubota I, Meguro T. Responsiveness to dobutamine stimulation in patients with left ventricular apical ballooning syndrome. Am J Cardiol 2007 100(10) 1600-3. 

Sonmez O, Duman C, Duzenli MA, Tokac M. Special attention for elderly women atypical left ventricular apical ballooning syndrome induced by dobutamine stress test a case report. J Am Geriatr Soc 2009 57(9) 1735-6. 

Jefic D, Koul D, Boguszewski A, Martini W. Transient left ventricular apical ballooning syndrome caused by abrupt metoprolol withdrawal. Int J Cardiol 2008 131 e35-7. 

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