Takotsubo cardiomyopathy after an upper and lower endoscopy: a case report and review of the literature

Perioperative management of Takotsubo cardiomyopathy: an overview

Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.

A Case Report of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Acute Pancreatitis Induced Takotsubo Cardiomyopathy (TCM) in a Patient With Gallstones Induced Acute Pancreatitis and Cholangitis

We present a case of a 30-year-old-patient, previously fit and well, with abdominal pain radiating to the back for a day. Computerized tomography scan of abdomen and pelvis showed gall bladder calculi and distal common bile duct (CBD) stones. Lab tests showed raised inflammatory markers including high amylase level, so she was treated for gallstones-induced pancreatitis. The patient underwent successful endoscopic retrograde cholangiopancreatography (ERCP) and was discharged. She presented to hospital the next day with severe central chest pain. ST segment elevation was detected on her electrocardiogram in inferolateral leads and ST segment depression in anterior leads. Her echocardiogram showed apical ballooning and blood tests showed elevated troponin T levels. The patient was given aspirin 300 mg and ticagrelor 180 mg stat, and morphine 5 mg intravenously. She also underwent coronary angiogram, which turned out to be normal. The patient was treated for ERCP-induced Takotsubo cardiomyopathy (TCM) and was treated with fluids and antibiotics. She made complete recovery and was discharged home with outpatient follow up. 

Cardiopulmonary arrest due to bronchoscopy-induced Takotsubo syndrome in a patient with antineutrophil cytoplasmic autoantibody-associated lung disease: a case report

Objective: Cardiac arrest (CA) has been observed in some patients with Takotsubo syndrome (TTS), most of whom had CA at the initial presentation of TTS. The objective of this report was to discuss the factors underlying the onset of this syndrome.

Case presentation: A 72-year-old woman with refractory antineutrophil cytoplasmic autoantibody-associated lung disease was referred to our hospital. Twenty minutes after bronchoscopic examination, cardiopulmonary arrest suddenly occurred. Resuscitation immediately resumed her heartbeat and spontaneous breathing. Subsequent 12-lead electrocardiography, echocardiography, and left ventricular angiography revealed TTS.

Conclusion: This case indicates that bronchoscopy can cause severe TTS, especially in patients with systemic inflammation.

Acute Takotsubo cardiomyopathy as a complication of transoesophageal echocardiogram

A 52-year-old woman, referred for transoesophageal echocardiography, developed acute Takotsubo cardiomyopathy during the examination as a result of emotional distress beforehand. Asymptomatic left ventricular apical ballooning with severe systolic dysfunction within minutes of the emotional trigger was the first sign of any abnormality.

Stress-induced cardiomyopathy after nephrectomy in a patient with a kidney cancer: a case report

Stress-induced (takotsubo) cardiomyopathy is a rare disease, which characterized by transient left ventricle dysfunction in response to a trigger factor (stress or severe somatic disease with surgical intervention) and is manifested by symptoms of acute coronary syndrome, but without significant coronary artery damage. In the population, the disease most often observes in postmenopausal women. Every year, more and more cases of takotsubo cardiomyopathy described in the literature, mainly after a severe stress. The presented article describes a case report of takotsubo cardiomyopathy after nephrectomy in a patient with comorbidity.