Mechanical circulatory support with intra-aortic balloon pump (IABP) can aid in the treatment of cardiogenic shock but may rapidly become detrimental due to the reduction in systolic arterial afterload in patients with predispositions to SAM and DLVOTO.

Life-threatening ACEI induced angioedema can develop at any stage of therapy and requires sometimes repeated administration of Icatibant. Adrenaline should not be used to treat ACEI-induced angioedema, except in cases where the diagnosis of anaphylaxis is not excluded.

Recovery of reversed Takotsubo cardiomyopathy is associated with hyperdynamic basal LV segments and can provoke DLVOTO when coupled with other anatomical, physiological or iatrogenic predisposing factors. Adrenaline and inodilators should be avoided or used with extreme caution. Echocardiographic monitoring is essential when treating patients with Takotsubo, who may develop DLVOTO.

When assessing the LVOT gradient by Doppler, it is important to identify both the MR jet and LVOT jet. The velocity of the MR jet will always be greater and Doppler profile more rounded, while the LVOT CWD signal with be “dagger shaped”.

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