Early Adaptation of Temporary Mechanical Circulatory Support in a Case of Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock after Cardiac Arrest and Prolonged Long QT
Evidence is limited on the best management strategies to ensure adequate cardiac function after out of hospital cardiac arrest found to be due to ventricular arrhythmia from Takotsubo Cardiomyopathy (TC). With a small number of TC cases subsequently leading to cardiogenic shock with biventricular failure, even less is known regarding optimal treatment approaches. Here, we present a unique case of a middle-aged female brought into the hospital after multiple out of hospital cardiac arrests, likely from TC associated ventricular arrhythmia from acquired long QT syndrome, that went onto develop severe cardiogenic shock with biventricular failure. Although management of cardiogenic shock is typically through inotropes and vasopressors, these medications have adverse effects including decreasing end organ perfusion and increasing myocardial oxygen consumption, potentially making them harmful in TC. The decision was made to treat the patient with temporary mechanical circulatory support using just left-sided Impella CP device, which resulted in dramatic hemodynamic improvement. This case emphasizes how early use of temporary mechanical circulatory support in the form of Impella CP can improve outcomes in patients with severe cardiogenic shock from TC. 2. Keywords: Cardiogenic Shock; Impella CP; Long QT Syndrome; Mechanical Circulatory Support; Takotsubo Cardiomyopathy