ABSTRACT
A 73-year-old male with end-stage heart failure underwent insertion of the HeartMate 3 (Abbott, North Chicago, IL, USA) device. Systemic anticoagulation and antiplatelets were discontinued for 52 days due to postoperative bleeding. After hemorrhage resolution, we restarted warfarin monotherapy targeting an international normalized ratio of 1.8-2.5. Eight months later, there are no reports of pump thrombosis, thromboembolism, and bleeding.
ABSTRACT
An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.
