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

Ruiz, S.; Martínez-Marín, M.; Luqué, Pilar; Nassar, N. E.

doi:10.1111/jog.13212

Cited by 17 publications

(13 citation statements)

References 16 publications

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“…One-third of these cases were found during caesarean section. All patients with Takotsubo cardiomyopathy recovered between 4 days and 3 months, as in non-pregnant patients with Takotsubo cardiomyopathy 42…”

Section: Other Cardiomyopathiesmentioning

confidence: 85%

Cardiomyopathy and pregnancy

Schaufelberger

2019

Heart

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Cardiomyopathy is a group of disorders in which the heart muscle is structurally and functionally abnormal in the absence of other diseases that could cause observed myocardial abnormality. The most common cardiomyopathies are hypertrophic and dilated cardiomyopathy. Rare types are arrhythmogenic right ventricular, restrictive, Takotsubo and left ventricular non-compaction cardiomyopathies. This review of cardiomyopathies in pregnancy shows that peripartum cardiomyopathy is the most common cardiomyopathy in pregnancy. Peripartum cardiomyopathy develops most frequently in the month before or after partum, whereas dilated cardiomyopathy often is known already or develops in the second trimester. Mortality in peripartum cardiomyopathy varies from <2% to 50%. Few reports on dilated cardiomyopathy and pregnancy exist, with only a limited number of patients. Ventricular arrhythmias, heart failure, stroke and death are found in 39%–60% of high-risk patients. However, patients with modest left ventricular dysfunction and good functional class tolerated pregnancy well. Previous studies on >700 pregnancies in 500 women with hypertrophic cardiomyopathy showed that prognosis was generally good, even though three deaths were reported in high-risk patients. Complications include different types of supraventricular and ventricular arrhythmias, heart failure and ischaemic stroke. Recent studies on 200 pregnancies in 100 women with arrhythmogenic right ventricular cardiomyopathy have reported symptoms, including heart failure in 18%–33% of pregnancies. Ventricular tachycardia was found in 0%–33% of patients and syncope in one patient. Information on rare cardiomyopathies is sparse and only presented in case reports. Close monitoring by multidisciplinary teams in referral centres that counsel patients before conception and follow them throughout gestation is recommended.

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Section: Other Cardiomyopathiesmentioning

confidence: 85%

Cardiomyopathy and pregnancy

Schaufelberger

2019

Heart

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“…Most of the reported TTS cases in pregnant women happened after childbirth with caesarean delivery, but TTS has also been reported in women during pregnancy. Similar to non‐pregnant patients with TTS, recovery occurred between 4 days and 3 months 59 …”

Section: Specific Cardiomyopathiesmentioning

confidence: 68%

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Meer

Petrie

et al. 2021

European J of Heart Fail

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This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non‐classified cardiomyopathies, left ventricular non‐compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo‐/radiotherapy for cancer or haematological malignancies need specific pre‐, during and post‐pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.

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“…The second possibility regards the hyperadrenergic state. A study mentioned above demonstrated that of 20 patients with pregnancy‐associated TTS, TTS occurred in the intraoperative period in five patients, a high percentage . Indeed, studies showed a close association between TTS and the hyperadrenergic status .…”

Section: Discussionmentioning

confidence: 97%

“…A study mentioned above demonstrated that of 20 patients with pregnancy-associated TTS, TTS occurred in the intraoperative period in five patients, a high percentage. 11 Indeed, studies showed a close association between TTS and the hyperadrenergic status. 1,10,12 PE is also associated with increased sensitivity to endogenous adrenaline.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome occurring concomitantly with pre‐eclampsia: A case report

Horie

Takahashi

Fujimoto

et al. 2019

J of Obstet and Gynaecol

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Takotsubo syndrome (TTS) patients show transient ventricular dysfunction without coronary artery stenosis. We report a pregnant woman with TTS occurring concomitantly with severe pre‐eclampsia (PE). A primiparous woman complained of dyspnea at 35 weeks of gestation. She showed severe PE, and cardiac ultrasound identified akinesis of the anterior lower wall. On the same day, emergent cesarean section was performed due to a nonreassuring fetus status, yielding a male infant with an umbilical artery pH of 6.851. Unfortunately, the neonate died of multiple organ failure. Following the delivery, her cardiac function markedly improved, and coronary angiography showed no coronary artery stenosis. Considering the clinical findings, we diagnosed the patient with TTS. Regarding antenatally occurring TTS, only six patients have been reported including the present one. Of the six patients, three had severe PE. Although previous reports on pregnancy‐associated TTS described good maternal outcomes, antenatally occurring TTS complicated by severe PE may become critical for fetuses.

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

Cited by 17 publications

References 16 publications

Cardiomyopathy and pregnancy

Cardiomyopathy and pregnancy

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Takotsubo syndrome occurring concomitantly with pre‐eclampsia: A case report

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