Takotsubo cardiomyopathy complicating a twin pregnancy at partum

Abstract

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Takotsubo cardiomyopathy in peripartum period: a case report

“…6 However, proposed pathophysiological mechanisms include transient coronary artery spasm, catecholamine excess, microvascular dysfunction triggered by an unclear mechanism. 4 Hypo or akinesia usually occurs in apical segment of left ventricle in majority of the cases and uncommonly in midsegment or basal segments. When it occurs in basal segment of the left ventricle, it is termed as reverse takotsubo cardiomyopathy.…”

“…Takotsubo cardiomyopathy is associated with in-hospital mortality of 2 %, in-hospital complication rate of 19 % like heart failure, arrhythmias, thrombus formation etc. 4 Its recurrence rate is up to 5%. 4 Patients with TC have a good prognosis as they recover soon after delivery within days to 3 months.…”

“…4 Its recurrence rate is up to 5%. 4 Patients with TC have a good prognosis as they recover soon after delivery within days to 3 months. 13 Diagnosis of TC is made using Heart Failure Association-European Society of Cardiology Criteria (Table 1).…”

“…It is a clinical syndrome characterised by an acute and transient (21 days) left ventricular systolic (and diastolic) dysfunction often related to an emotional or physical stressful event, most often identified in the preceding days (1 to 5 days). [1][2][3][4] It is a cardiac emergency and a diagnosis of exclusion. 1 Takotsubo cardiomyopathy was originally described in Japan in 1990s.…”

“…3 TC is also known with many other names such as apical ballooning syndrome, broken heart syndrome and stress cardiomyopathy. 4,5 Takotsubo cardiomyopathy is often precipitated by intense emotional or physical stress. 6 Women are more affected than men and usually in postmenopausal state and not so commonly seen in pregnant population.…”