Current management of cardiogenic shock from stress-induced cardiomyopathy: Consideration of catecholamine excess and left ventricular outflow tract obstruction

Author(s): Sun-Joo Jang, Abhinav Aggarwal, Carlos D. Davila

Stress-Induced Cardiomyopathy (SIC) or Takotsubo cardiomyopathy is usually a reversible myopathy precipitated by emotional or physical stress. The important pathophysiology underlying SIC includes excessive catecholamine leading to myocardial stunning and in certain occasions dynamic Left Ventricular Outflow Tract (LVOT) obstruction. Thus, cardiogenic Shock (CS) related to SIC (SIC-CS) would need a tailored strategy considering catecholamine excess and LVOT obstruction. Invasive hemodynamic monitoring is important to minimize the use of inotropics/vasopressors and decide the timing of Mechanical Circulatory Support (MCS). Early use of MCS in advanced SCAI shock stages may be important. The choice of MCS devices should be carefully assessed in the presence of severe LVOT obstruction. Further studies are needed to understand the safety, efficacy, and timing of MCS devices in patients with SIC-CS.