{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:42:06Z","timestamp":1760031726083,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Takotsubo cardiomyopathy (TCM), an acute stress-induced left ventricular dysfunction, stems from catecholaminergic surges leading to transient myocyte stunning, calcium overload, and microvascular dysregulation. Although most cases resolve spontaneously, roughly 10% deteriorate into fulminant cardiogenic shock, warranting mechanical circulatory support (MCS). Impella\u00ae provides direct transvalvular LV unloading but carries elevated risks of hemolysis, vascular compromise, and thrombogenicity. Conversely, the intra-aortic balloon pump (IABP) enhances diastolic coronary perfusion and marginally reduces afterload via counterpulsation, albeit with less potent LV decompression. Optimal MCS selection in TCM-associated shock therefore hinges on balancing hemodynamic benefits against procedural morbidity. Case Presentation: A 72-year-old female with coronary artery disease, paroxysmal atrial fibrillation (status post\u2013left atrial appendage occlusion), and stage 3 chronic kidney disease presented with anterior ST-segment elevations (V2\u2013V4) and troponin I &gt;1000 ng\/L, progressing rapidly to cardiogenic shock and respiratory failure. Coronary angiography revealed mild luminal irregularities, while echocardiography demonstrated severely reduced ejection fraction (5\u201310%) with characteristic apical ballooning. Refractory elevations in pulmonary capillary wedge pressure, despite escalating inotropes and vasopressors, prompted IABP insertion for partial LV offloading. Over one week, her ejection fraction improved to 35%, facilitating weaning from pressor support, extubation, and discharge on guideline-directed medical therapy. Conclusions: In TCM complicated by shock, meticulous MCS selection is paramount. Although Impella confers more robust unloading, heightened device-related complications may be unjustified in a largely reversible disease. IABP can sufficiently stabilize hemodynamics, enable myocardial recovery, and mitigate morbidity, underscoring the importance of individualized decision-making in TCM-related shock. Importantly, no trial has shown that MCS confers a proven long-term mortality benefit beyond initial hemodynamic rescue.<\/jats:p>","DOI":"10.3390\/reports8020043","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:47:44Z","timestamp":1743580064000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shock and Awe: The Tactical Trade-Offs of Impella\u00ae Versus Intra-Aortic Balloon Pump in Takotsubo Cardiomyopathy"],"prefix":"10.3390","volume":"8","author":[{"given":"Ajay","family":"Saraf","sequence":"first","affiliation":[{"name":"Internal Medicine Residency, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Goyal","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Premier Heart Institute, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical features and outcomes of Takotsubo (stress) cardiomyopathy","volume":"373","author":"Templin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1056\/NEJMoa043046","article-title":"Neurohumoral features of myocardial stunning due to sudden emotional stress","volume":"352","author":"Wittstein","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.amjcard.2020.09.014","article-title":"Comparison of outcomes in patients with Takotsubo syndrome with versus without cardiogenic shock","volume":"136","author":"Syed","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"oead003","DOI":"10.1093\/ehjopen\/oead003","article-title":"Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: Results from the German-Italian-Spanish (GEIST) registry","volume":"3","author":"Santoro","year":"2023","journal-title":"Eur. Heart J. Open"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ahmed, M., Bano, S., Asif, M., Sidra, F.N., Ram, M., and Bibi, S. (2024, January 7\u20138). Impella vs intra-aortic balloon pump in patients with acute myocardial infarction complicated with cardiogenic shock: An updated systematic review and meta-analysis. Proceedings of the International Student Research Conference (ISRC\u201924), Karachi, Pakistan.","DOI":"10.4081\/cardio.2025.61"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/S0140-6736(13)61783-3","article-title":"Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomized, open-label trial","volume":"382","author":"Thiele","year":"2013","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"oead050","DOI":"10.1093\/ehjopen\/oead050","article-title":"Clinical implication of intra-aortic balloon pumping in patients with Takotsubo syndrome and cardiogenic shock","volume":"3","author":"Teruhiko","year":"2023","journal-title":"Eur. Heart J. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.carrev.2021.11.018","article-title":"Impella mechanical circulatory support for Takotsubo syndrome with shock: A retrospective multicenter analysis","volume":"40","author":"Napp","year":"2022","journal-title":"Cardiovasc. Revasc. Med."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/2\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:08:40Z","timestamp":1760029720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/2\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":8,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["reports8020043"],"URL":"https:\/\/doi.org\/10.3390\/reports8020043","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}