Figure 3.

Management of patients with Takotsubo syndrome and hypotension. LVOTO: left ventricular outflow tract obstruction; MCS: mechanical circulatory support; VA-ECMO: veno-arterial extracorporeal membrane oxygenation; IABP: intra-aortic balloon pump (or intra-aortic balloon counterpulsation). * If acute coronary syndrome has not yet been ruled out, patients should undergo coronary angiography first. Slow pullback of pigtail catheter from left ventricular (LV) cavity allows early invasive assessment of intraventricular pressure gradients and can rule out LVOTO [7]. ^# Careful fluid administration should occur in consideration of LV ejection fraction and only in absence of acute heart failure with pulmonary oedema. ^§ Ventricular thrombus and severe pulmonary congestion should be excluded, alternatively consider VA-ECMO.