Bulgarian Cardiac Institute

The ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. The key to management is an aggressive approach to hemodynamic stabilization and surgical closure of the rupture. If a patient with a small rupture is in hemodynamicaly stable condition, surgery can be delayed to achieve better perioperative results. In unstable patients either urgent surgery or extracorporeal membranous oxygenation support and delayed surgery is indicated. In some patients transcatheter closure can be considered as an alternative to surgery

Rational pharmacotherapy in Takotsubo cardiomyopathy is based on clinical picture and data of functional and laboratory investigations of concrete patient. In patients with hypotension and moderate-to-severe left ventricle outflow tract obstruction inotropic agents must not to be used because they can worsen the degree of obstruction. In these patients beta blockers can improve hemodynamics by causing resolution of the obstruction. If intraventricular thrombus is detected, anticoagulation for at least 3 months is recommended. The duration of anticoagulant therapy may be modified depending on the extent of cardiac function recovery and thrombus resolution. For patients without thrombus but with severe left ventricular dysfunction, anticoagulation is recommended until the akinesis or dyskinesis has resolved but not more than 3 months.