Tako-tsubo syndrome soon after caesarean delivery: two case reports

Citro, Rodolfo; Giudice, Roberta; Mirra, M.; Bottiglieri, G; Bossone, Eduardo; Benedetto, Giuseppe Di; Piscione, Federico

doi:10.1016/j.ijcard.2012.04.073

Cited by 13 publications

(8 citation statements)

References 6 publications

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“…[4][5][6] Several cases have been reported around the time of cesarean delivery. [6][7][8][9][10][11] Unlike our case, these were not associated with eclampsia. In 1 case series, 13 women who had elective cesarean delivery developed symptoms intraoperatively or within 24 hours postdelivery.…”

Section: Discussioncontrasting

confidence: 65%

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

Gleich¹,

Barbara

Arendt

et al. 2016

A & A Case Reports

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The diagnosis of heart failure during pregnancy has important management implications for the parturient and her fetus. A 19-year-old primigravida developed eclampsia at 29 weeks' gestation. Echocardiography demonstrated normal left ventricular size and ejection fraction of 35% with reverse apical ballooning (reverse takotsubo pattern). Under general anesthesia with invasive monitoring, she underwent urgent cesarean delivery of a preterm infant. Follow-up echocardiography 4 weeks after delivery showed complete normalization of her ejection fraction (56%). This case of eclampsia-related stress-induced cardiomyopathy is a distinct entity from peripartum cardiomyopathy. Using echocardiography, the diagnoses should be differentiated with appropriate management and counseling.

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Section: Discussioncontrasting

confidence: 65%

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

Gleich¹,

Barbara

Arendt

et al. 2016

A & A Case Reports

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show abstract

“…It has been shown that SIC predominantly affects postmenopausal woman [ 1 ]. Although several cases of SIC in young woman have already been described, pregnancy associated SIC (P-SIC) appears to be rather unusual [ 3 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

Inverted stress- induced cardiomyopathy as a unusual variant of acute heart failure after cesarean delivery- a case report

Ledakowicz-Polak

Bartodziej

Majos

et al. 2016

BMC Cardiovasc Disord

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BackgroundStress- induced cardiomyopathy is acute, reversible left ventricle mainly apical dysfunction in patients with normal coronary angiography. Rarely it regards basal segments, therefore defined as “inverted stress- induced cardiomyopathy”. While classic form mostly affects postmenopausal women, inverted variant occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. Herein we report such unique case of 36- year old woman after cesarean delivery.Case presentationA 36- year- old white woman at 40 week of gestation was admitted to hospital for elective repeated cesarean delivery. During caesarean delivery under spinal anaesthesia a previously healthy woman became hypotensive, requiring ephedrine to maintain her blood pressure. Three hours after delivery the patient presented acute heart failure and pulmonary oedema. Due to low blood pressure she demanded the administration of inotropic agents. Owing to respiratory failure and gradual deterioration of consciousness, mechanical ventilation was applied. Results of additional tests finally excluded pulmonary thromboembolism and acute coronary syndrome. The transthoracic echocardiography revealed severe left ventricular systolic dysfunction, ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments. The diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data. Both echocardiography and magnetic resonance imaging performed on the fifth day showed complete recovery of myocardial function. The patient was discharged after 15 days in good overall condition. At 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities.ConclusionsInverted stress- induced cardiomyopathy may occur in postpartum period, especially in combination with spinal anesthesia and adrenergic stimulants administration. The clinical awareness and multimodality imaging of possible diagnosis and further management of this unexpected variant of acute heart failure after caesarean delivery is required.

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“…Takotsubo syndrome has already been described as complicating the postoperative course of major general surgery operations. Rodrigues et al reported a case of TC occurring after an open gastrectomy, and TC was also described as a complication of liver transplant or even of caesarean section …”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Following Cardiac Surgery

et al. 2015

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Background: Takotsubo cardiomyopathy syndrome, commonly occurring in postmenopausal women, is characterized by transient apical systolic dysfunction in absence of coronary lesions. The cardiomyopathy is often observed after intense stressful events such as a major surgical procedure. Methods: A 72-year-old woman symptomatic for dyspnea at rest, chest pain, and peripheral edema successfully underwent surgery for noncoronary sinus aneurysm-right atrium fistula repair. Two days after surgery the patient developed takotsubo syndrome, diagnosed according to the Mayo Clinic criteria. We reviewed the literature on takotsubo cardiomyopathy as a complication of major cardiac surgery procedures. Results: Takotsubo cardiomyopathy is confirmed as a possible early complication of cardiac surgery. Exaggerated sympathetic stimulation may cause massive endogenous catecholamine release. Hypoperfusion during cardiopulmonary bypass, inotropic drugs administration, and postoperative anxiety and pain are all factors generating stress, possible coronary artery spasm and transient cardiomyopathy, clinically simulating acute myocardial infarction. Several clinical features have been described such as acute mitral insufficiency, systolic anterior motion of the anterior mitral valve leaflet, left ventricular outflow tract obstruction, acute cardiac failure, and cardiogenic shock. Intraventricular thrombi and adverse cerebrovascular events may also be possible complications. Rare catastrophic events such as left ventricular free wall rupture and ventricular septal perforation have been also encountered. Conclusions: After cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started.

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Tako-tsubo syndrome soon after caesarean delivery: two case reports

Cited by 13 publications

References 6 publications

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

Inverted stress- induced cardiomyopathy as a unusual variant of acute heart failure after cesarean delivery- a case report

Takotsubo Cardiomyopathy Following Cardiac Surgery

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