Reverse Takotsubo Syndrome, a Case Report of a Rare Cause for Postpartum Heart Failure

Abstract

Predominant causes for newly diagnosed postpartum heart failure are preeclampsia and peripartum cardiomyopathy. Being an anatomical variant of Takotsubo syndrome (TTS) reverse TTS in this period is rare. We present a 36 year old patient, who had delivered triplets by cesarean section. Because of postpartum bleeding she was administered sulprostone. Later she was transferred to the Intensive Care Unit with sudden development of dyspnea, tachypnea and tachycardia. Clinical symptoms, laboratory findings and chest radiograph showed signs of acute heart failure. Transthoracic echocardiography (TTE) revealed reverse TTS with moderately reduced left ventricular ejection fraction (LVEF 39%). The patient stabilized with loop diuretic, angiotensine-converting enzyme inhibitors and beta-blockade. Breast-feeding was discouraged and bromocriptine administered. Left ventricular function normalized (LVEF 60%) within four weeks. TTS should be considered in patients with early postpartum development of heart failure. Rapid cardiac recompensation after the start of adequate therapy and complete resolution of clinical symptoms and TTE findings are typical for postpartum TTS.

Takotsubo cardiomyopathy in peripartum period: a case report

“…When it occurs in basal segment of the left ventricle, it is termed as reverse takotsubo cardiomyopathy. 11,12 Patients usually present with chest pain and/or breathlessness and it can occur even during the time of caesarean as in this patient who became symptomatic on operative table. This patient was very apprehensive due to much awaited pregnancy conceived after 12 years of married life and also due to unexpected very early rupture of membranes with the necessity of urgent preterm delivery.…”

Inverted Takotsubo Syndrome With HELLP Syndrome: A Case Report

“…In the case presented here, the onset of Takotsubo syndrome post-partum occurred soon after spontaneous vaginal delivery, whereas it generally occurs several days later ( 26 ). Takotsubo syndrome is much more common after cesarean section than after vaginal delivery because several risk factors are associated with it, including the psychological and physical stress associated with cesarean section, acute pain and bleeding causing increased catecholamine levels, and use of uterotonic or tocolytic treatments ( 26 , 27 ). Takotsubo syndrome is often associated with a preceding stressful physical or emotional event ( 5 ); physical triggering factors are more prevalent than emotional triggers.…”

(Reverse Takotsubo syndrome, a rare form of "Broken Heart" syndrome)

“…13,14 V literatuře byly popsány některé zajímavé případy jako iatrogenní vznik rTTS po 70násobně vyšší aplikaci noradrenalinu v kontinuální infuzi při poškození injektorové pumpy, rTTS po dobutaminové zátěžové echokardiografi i, postpartální srdeční selhání způsobené rTTS, rTTS u spinálního subdurálního hematomu, po předávkování amfetaminem a případ pacientky s klasickou formou TTS a reverzní formou TTS v průběhu jednoho roku. [17][18][19][20][21][22] V diagnostice tohoto syndromu nesmíme zapomínat na pečlivý odběr anamnézy v předchorobí, s udávanou stresovou psychickou či fyzickou situací. Subjektivně mají pacienti zejména bolesti na hrudi imitující typické stenokardie, palpitace, dušnost, klinicky známky srdečního selhání, ale první manifestací může být i synkopa při maligní arytmii či rozvoj kardiogenního šoku.…”