Takotsubo Cardiomyopathy: A Cardiac Syndrome Mimicking Acute Myocardial Infarction in a Liver Transplant Recipient

Abstract

Takotsubo cardiomyopathy (TTC) is a rare clinical syndrome defined as a profound but reversible left ventricular dysfunction in the absence of coronary artery disease. We describe the clinical features and management of TC manifesting in the postoperative period in a patient undergoing liver transplantation. Two days after surgery, the patient developed clinical features of acute myocardial infarction. Ecochardiography revealed hypokinesis of the left ventricle. Coronary angiography revealed normal arteries without any stenosis or obstruction. The patient required vasopressor and inotropic support. The placement of intra-aortic balloon pump had a beneficial effect on the management of heart failure. The patient had a complete recovery of cardiac function 40 days after surgery. TC is a possible occurrence after liver transplant. Awareness of this condition is essential as early diagnosis and prompt management can save the patient’s life.

Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients

“…It took 23 post-op days for the myocardial function to recover enough for IABP removal, and a total of 35 days to achieve an EF of 30%, to start inotropic support weaning process. The patient was discharged on POD 40, with good overall myocardial function, and did well thereafter (58). In similar case, TC occurred postoperatively on POD 1.…”

Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis

“…[3] TCMP has been rarely reported in liver transplantation recipients (LTRs), with only few cases reported in the literature. [4][5][6][7] Approximately 20 cases of TCMP were recorded in the LT registry of Toronto General Hospital, Ontario, Canada, from approximately 1000 LTs performed in the last 10 years (personal communication). This gives a prevalence of TCMP of approximately 2% in LTRs from a single center.…”

Does autonomic re‐innervation cause Takotsubo syndrome in a transplanted heart? Comment on: “Takotsubo cardiomyopathy in a young adult with transplanted heart: what happened to denervation?” by Chinali et al.

“…3 There are a number of case studies on TTS occurring in the acute, subacute, or chronic phase after lung, 4 renal, 5,6 and liver transplantation. 7,8 Besides emotional and physical stress associated with transplantation and post-transplantation recovery, combined immunosuppressive therapy might have contributed to the development of TTS. 5 Therefore, it would be interesting to know which immunosuppressive regimen was applied and if there was a pre-medication with betablockers, ACE-inhibitors, or oral contraceptives.…”