Takotsubo cardiomyopathy in the post-anesthetic care unit

Abstract

Takotsubo cardiomyopathy is a transient a left ventricular dysfunction that may mimic an acute coronary syndrome. Characteristically, it presents with chest pain of acute onset, electrocardiographic alterations suggestive of myocardial ischemia, and transient akinesis of the apex and the distal portion of the left ventricular anterior, lateral and inferior walls, with compensatory hyperkinesis of the basal walls. These changes in myocardial contractility make the ventricle acquire the typical appearance of a «takotsubo», a Japanese word that refers to a vessel used as an octopus trap. It is frequently triggered by psychological or physical stress in postmenopausal women. Ventricular function recovers quickly and prognosis is excellent.

There are several case reports of associations between anesthesia and surgery with Takot-subo cardiomyopathy. The adrenergic discharge during or after anesthesia may affect the myocardium and give rise to transient ventricular dysfunction in some patients. We describe a case of Takotsubo cardiomyopathy in a patient undergoing eye surgery.

The case is of a 72-year-old patient scheduled for cataract surgery under general anesthesia. Functional class was normal and there were no special events during the procedure. In the post-anesthetic care unit, the patient had an episode of respiratory failure associated with an inverted T-wave. The transthoracic echocardiogram revealed ventricular dysfunction, and the coronary arteriogram showed normal coronary arteries. The patient was diagnosed with Takotsubo cardiomyopathy and she recovered normal ventricular function within 4 weeks.

Conclusions: Takotsubo cardiomyopathy is a reversible ventricular dysfunction, and there is a growing number of cases described in the literature in relation to anesthesia. Anesthetists must be aware of this condition every time there is cardiac dysfunction or hemodynamic collapse in the perioperative setting.