Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section

Abstract

Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.

Takotsubo cardiomyopathy after cesarean section: A case report and literature review

“…The onset of TCM may be related to physical and emotional stress that releases catecholamines. Another hypothesis is that the catecholamines/vasoconstrictive substances that are administered during CS may cause TCM to occur; drugs are usually used during intervention to counteract the hypotension induced by epidural or spinal anesthesia . In our case, the anesthetist used ephedrine in the operating room.…”

“…Takotsubo cardiomyopathy is known to occur more frequently in menopausal women . As a result, very few cases of TCM have been reported in young or pregnant women.…”

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

“…Because of this patient's clinical and echocardiographic recovery in <4 weeks, this case is a separate clinical entity from classic Stress-induced cardiomyopathy, including apical ballooning (takotsubo) and reverse apical ballooning (reverse takotsubo) cardiomyopathies, has been reported during the peripartum period. [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.…”

“…[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.…”

Takotsubo cardiomyopathy in pregnancy: a case report and literature review

“…However, up to 20% of affected patients have no identifiable stressors [1, 7]. Majority of TCM cases in pregnancy are described in the peripartum period irrespective of the mode of delivery [8–10] making it difficult to differentiate TCM from peripartum cardiomyopathy [5].…”