Myocardial contrast echocardiography in the diagnosis of postoperative takotsubo myocardiopathy: case report and literature review

Abstract

BackgroundTakotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period.Case presentationA 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment.ConclusionThis report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.

Takotsubo Syndrome: Finally Emerging From the Shadows?

“…Takotsubo syndrome was initially attributed to multivessel coronary artery spasm, and certainly coronary vasoconstriction is sometimes observed during the acute stages of TTS [1,24]. The theory of a causative role for coronary spasm, although still sometimes promulgated, has a number of obvious weaknesses: (i) ischaemia due to abnormal coronary reactivity would tend to induce regions of LV hypokinesis congruent with the distribution of particular major coronary arteries and (ii) patients with chronic coronary artery spasm rarely suffer myocardial injury, and (iii) a number of investigators have failed to detect evidence of myocardial ischaemia during the acute phase of TTS [25]. However, these facts have not completely abolished enthusiasm for the idea that TTS is fundamentally a transient ACS [26].…”

The Clinical Course of Takotsubo Syndrome Diagnosed According to the InterTAK Criteria

“…The InterTAK criteria, similar to previous diagnostic criteria for TTS, do not mention the occurrence of the syndrome in the postoperative period of cardiac surgery, 11 i.e., do not confirm or exclude the diagnosis of TTS such case. However, due to the increasing number of TTS following cardiac surgery reported in the literature, [12][13][14][15] we decided to include these patients in the analysis.…”

Takotsubo Syndrome and Electroconvulsive Therapy: Time for Rigorous Assessment

“…We followed with interest the recent debate ignited by several commentaries on Takotsubo Syndrome (TTS), adrenergic activation in mood disorder patients, and the associated clinical and public health implications appraised both in the Journal of Clinical Practice and Epidemiology in Mental Health (CPEMH) [1-4] and in other peer-reviewed sources [5, 6]. An important issue deals with the putative connection between Electroconvulsive Therapy (ECT) and subsequent TTS.…”