ST-segment elevation during general anesthesia for non-cardiac surgery: a case of takotsubo

Case of takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst: A case report

BACKGROUND

Takotsubo cardiomyopathy, also called apical ballooning syndrome, is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome. The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst.

CASE SUMMARY

A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst, and no cardiac problems were found. The patient was discharged on the 3rd postoperative day without any postoperative complications. On postoperative day 5, the patient presented to the emergency department with fever, shortness of breath, chills, and shivering and was hospitalized with the diagnosis of pneumonia. The troponin levels remained high during follow-up. Echocardiography was performed on postoperative day 7, after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region. Coronary angiography performed at the tertiary center showed normal coronary anatomy, and the patient was diagnosed with takotsubo cardiomyopathy.

CONCLUSION

Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.

Takotsubo Cardiomyopathy Precipitated By Thyroidectomy - A Case Report

Takotsubo cardiomyopathy (TC) is an acute cardiac condition triggered by emotional or physical stress. General anesthesia and sympathetic activation are possible triggers for TC. However, little is known about the role of sympathovagal activity in TC. In our report, we present a female patient, aged 62, who underwent thyroidectomy and at the end of the surgery developed cardiac complications. The patient had no chest pain, but had ST depression and negative T waves on the electrocardiogram (ECG). Cardiospecific enzyme troponin was elevated. Cardiac catheterization revealed unobstructed coronary arteries. Echo-cardiography revealed the enlargement of the left ventricle and ejection fraction of 40%. The patient was diagnosed with TC and dual antiplatelet therapy was introduced, a beta blocker and ACE inhibitor.It is possible that TC in perioperative period after thyroidectomy in this patient occured due to both sympathetic and parasympathetic activation. Probably, extraction of large thyroid induced vagal stimulation which resulted in hypotension and bradicardia. The patient was subsequently treated with adrenaline and atropine. In this case, sympathetic and parasympathetic activation in different intervals could result in the development of this condition.

ST Elevations and Ventricular Tachycardia Secondary to Coronary Vasospasm upon Extubation

ST elevations (STE) in the perioperative setting can result from a number of different etiologies, the most common and feared being acute coronary syndrome (ACS). However, other causes should be considered, as treatment may differ depending on the diagnosis. Here, we describe a case of STE and ventricular tachycardia in a patient at high risk for ACS. The patient had a prior diagnosis of coronary vasospasm; however, given pre-existing risk factors, much consideration and deliberation occurred prior to electing conservative therapy. This report provides an overview of perioperative vasospasm and other causes of STE, which anesthesiologists should be aware of.