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Haemodynamic effects of acute intravenous landiolol in Takotsubo cardiomyopathy with dynamic left ventricular outflow tract obstruction
  1. YeJi Cho1,
  2. Kenji Inoue2,
  3. Mitsuhiro Kunimoto2 and
  4. Tohru Minamino1
  1. 1Cardiovascular Biology and Medicine, School of Medicine, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
  2. 2Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
  1. Correspondence to Dr Kenji Inoue; inouelsbm{at}


Takotsubo cardiomyopathy (TCM) leads to serious left ventricular outflow tract (LVOT) obstruction with cardiogenic shock in 6%–20% of cases. The onset of LVOT obstruction, coupled with mitral regurgitation resulting from systolic anterior motion of mitral valve leaflets, can lead to haemodynamic instability in addition to severely impaired systolic function. We describe three patients who experienced chest discomfort following emotional stress. These patients displayed pronounced abnormalities on ECGs, insignificant obstructive coronary disease and haemodynamic instability due to LVOT obstruction. The infusion of landiolol, a short-acting beta blocker, was effective in releasing the gradient. Dynamic outflow obstruction is the major predictor of haemodynamic collapse. We suggested that an early identification of this complication in hypotensive patients with suspected TCM could be of utmost importance to optimise the therapeutic approach in the acute setting.

  • Heart failure
  • Drugs and medicines

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: YC, KI and MK. The following author gave final approval of the manuscript: TM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.