Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure

Abstract

We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM) immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT) surgery for stress urine incontinence). TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.

Takotsubo cardiomyopathy as an overlooked cause of cardiac arrest in a patient undergoing ureteral stenting: a case report and literature review

“…The results are shown in Table 2 . Among the eight cases, perioperative stress (six cases), 9 – 14 local anesthetic and epinephrine infiltration (one case), 15 and pheochromocytoma (one case) 16 were possible triggers. Furthermore, TC occurred preoperatively (one case), 14 intraoperatively (four cases) 9 , 13 , 15 , 16 and postoperatively (three cases).…”

“…Among the eight cases, perioperative stress (six cases), 9 – 14 local anesthetic and epinephrine infiltration (one case), 15 and pheochromocytoma (one case) 16 were possible triggers. Furthermore, TC occurred preoperatively (one case), 14 intraoperatively (four cases) 9 , 13 , 15 , 16 and postoperatively (three cases). 12 – 14 Previous patients also underwent different procedures, such as transurethral resection of a bladder tumor (TUR-BT), adrenalectomy, robotic radical cystectomy, and others.…”

“…Furthermore, TC occurred preoperatively (one case), 14 intraoperatively (four cases) 9,13,15,16 and postoperatively (three cases). [12][13][14] Previous patients also underwent different procedures, such as transurethral resection of a bladder tumor (TUR-BT), adrenalectomy, robotic radical cystectomy, and others. However, no case report mentioned CA resulting from TC after ureteral stenting.…”

Perioperative management of Takotsubo cardiomyopathy: an overview

“…These effects can represent vital aspect able to spare the stress associated with tracheal intubation and extubation [ 63 ]. However, published case reports describe the onset of stress cardiomyopathy immediately after the spinal anaesthesia; consequently, it can be speculated that not all loco-regional anaesthesia techniques can be considered “stress-free” [ 64 , 65 ]. Compared to neuraxial technique which may potentially have a greater haemodynamic impact, peripheral nerve blocks appear to be safer, when appropriate for the type of intervention, in patients with a history of stress-induced cardiomyopathy [ 63 ].…”