Takotsubo cardiomyopathy – An unexpected complication in spine surgery

Abstract

HighlightsAn impressive case of Takotsubo developed during neurosurgery in a 53 year-old female Takotsubo mimicked the clinical signs of an acute myocardial infarction The patient recovered completely within one week under symptomatic therapy Takotsubo may be triggered by pain, anxiety or high catecholamine levels Interventions in neurosurgery should be kept as stress free as possible.

Takotsubo cardiomyopathy following resection of a fourth ventricle tumour

“…Takotsubo cardiomyopathy may present in the peri‐operative period in a myriad of ways including pulmonary oedema, ECG changes, elevation of cardiac enzymes, hypotension, cardiogenic shock or cardiac arrest . The two most commonly described symptoms are acute substernal chest pain and dyspnoea, both being described on emergence . In our case despite our initial concerns of the potential for myocardial dysfunction, we were falsely reassured by the physiological stability in the immediate postoperative phase.…”

“…There are no controlled data to define an optimal medical regimen, but it seems reasonable to treat these patients with the standard medications that are used for left ventricular systolic dysfunction, including β‐adrenergic antagonists, angiotensin‐converting enzyme (ACE) inhibitors and diuretics. Medications such as β‐blockers are often advocated to counteract the hyper‐catecholamine state, while ACE inhibitors or angiotensin receptor blockers may improve survival at 1 year .…”

“…Patients who survive the acute episode typically recover normal ventricular function within 4 weeks , but it is important to note that mortality in takotsubo cardiomyopathy is similar to that of acute myocardial infarction. A 30‐day risk of major adverse cardiac and cerebrovascular events of 5.9% has been reported with a mortality rate of 5.6% per year, and the rate of stroke or transient ischaemic attack of 1.7% .…”

“…Takotsubo cardiomyopathy is characterised by the acute onset of reversible left ventricular dysfunction in the absence of obstructive coronary disease . The condition typically occurs due to episodes of severe emotional or physical stress, with the putative mechanism that the exaggerated sympathetic stimulation results in catecholamine‐induced microvascular spasm with subsequent myocardial dysfunction and stunning .…”

Miocardiopatía por estrés: análisis de 17 casos

“…Dentro de los psicológicos se han reportado diversas situaciones (negativas o positivas), así como una gran variabilidad en la intensidad de estos gatillos 8 . También los desencadenantes físicos descriptos corresponden a diferentes etiologías tales como, esfuerzo físico extremo, patologías clínicas agudas, exacerbaciones de patologías crónicas, cirugías mayores, quimioterapia e inducción anestésica [9][10][11][12][13][14][15][16][17][18][19] . La presentación clínica típica corresponde a la de un SCA, con dolor precordial anginoso, signosintomatología simpática, disnea de esfuerzo y cambios electro-cardiográficos de isquemia o injuria; también puede presentarse asintomático o con ángor atípico, disnea, síncope, palpitaciones, náuseas y/o emesis, mialgias, falla cardíaca aguda, arritmia ventricular, shock cardiogénico, paro cardiorrespiratorio e incluso muerte súbita .…”