{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:59:50Z","timestamp":1780981190720,"version":"3.54.1"},"reference-count":21,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,8,30]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>Takotsubo cardiomyopathy (TCM) leads to serious left ventricular outflow tract (LVOT) obstruction with cardiogenic shock in 6%\u201320% 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.<\/jats:p>","DOI":"10.1136\/bcr-2023-255987","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T13:05:51Z","timestamp":1697461551000},"page":"e255987","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Haemodynamic effects of acute intravenous landiolol in Takotsubo cardiomyopathy with dynamic left ventricular outflow tract obstruction"],"prefix":"10.1136","volume":"16","author":[{"given":"YeJi","family":"Cho","sequence":"first","affiliation":[{"name":"Cardiovascular Biology and Medicine, School of Medicine, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-8421","authenticated-orcid":false,"given":"Kenji","family":"Inoue","sequence":"additional","affiliation":[{"name":"Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhiro","family":"Kunimoto","sequence":"additional","affiliation":[{"name":"Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohru","family":"Minamino","sequence":"additional","affiliation":[{"name":"Cardiovascular Biology and Medicine, School of Medicine, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"2025082707543482000_16.10.e255987.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.162"},{"key":"2025082707543482000_16.10.e255987.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406761"},{"key":"2025082707543482000_16.10.e255987.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy077"},{"key":"2025082707543482000_16.10.e255987.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.05.015"},{"key":"2025082707543482000_16.10.e255987.5","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10153235","article-title":"Dynamic left Intraventricular obstruction phenotype in Takotsubo syndrome","volume":"10","author":"Di Vece","year":"2021","journal-title":"J Clin Med"},{"key":"2025082707543482000_16.10.e255987.6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-320543"},{"key":"2025082707543482000_16.10.e255987.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.04.051"},{"key":"2025082707543482000_16.10.e255987.8","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/1755-5922.12182","article-title":"Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: results from a multicenter registry","volume":"34","author":"Santoro","year":"2016","journal-title":"Cardiovasc Ther"},{"key":"2025082707543482000_16.10.e255987.9","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1053\/j.jvca.2017.11.039","article-title":"Ultra-short-acting \u0392-blockers (Esmolol and Landiolol) in the perioperative period and in critically ill patients","volume":"32","author":"Poveda-Jaramillo","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025082707543482000_16.10.e255987.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.09.020"},{"key":"2025082707543482000_16.10.e255987.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.05.002"},{"key":"2025082707543482000_16.10.e255987.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2261-14-147","article-title":"Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in Takotsubo cardiomyopathy: a two-year, two-center experience","volume":"14","author":"De Backer","year":"2014","journal-title":"BMC Cardiovasc Disord"},{"key":"2025082707543482000_16.10.e255987.13","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1253\/circj.CJ-14-1148","article-title":"Clinical impact of left ventricular outflow tract obstruction in Takotsubo cardiomyopathy","volume":"79","author":"Kawaji","year":"2015","journal-title":"Circ J"},{"key":"2025082707543482000_16.10.e255987.14","first-page":"723","article-title":"Hypotension due to dynamic left ventricular outflow tract obstruction after percutaneous coronary intervention","volume":"38","author":"Dahhan","year":"2011","journal-title":"Tex Heart Inst J"},{"key":"2025082707543482000_16.10.e255987.15","first-page":"1074","article-title":"Long live \u0392-blockers in Takotsubo outflow obstruction! 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