Takotsubo cardiomyopathy precipitated by negative pressure pulmonary oedema following total thyroidectomy

Abstract

‘Takotsubo cardiomyopathy (TCM)’ or ‘stress cardiomyopathy’ is a reversible cardiomyopathy that is precipitated by intense emotional or physical stress. This syndrome is characterised by symptoms mimicking acute coronary syndrome with transient systolic dysfunction associated with regional wall motion abnormalities, which extend beyond a single coronary vascular bed in the absence of obstructive coronary vascular disease. The presentation of TCM and myocardial infarction is similar with sudden onset of chest pain, breathlessness as well as abnormalities in both the electrocardiogram and cardiac enzymes. It is difficult to differentiate between the two until cardiac catheterisation establishes the diagnosis. We report a case of TCM in a post-menopausal female, precipitated by negative pressure pulmonary oedema following total thyroidectomy in whom timely cardiac catheterisation established the diagnosis and influenced the management. Heightened awareness of this unique cardiomyopathy is essential to have a high index of suspicion in at-risk population for the prompt diagnosis of stress-related cardiomyopathy syndromes occurring in the perioperative period.

Negative pressure pulmonary edema after general anesthesia

“…Contou et al [21] performed a retrospective analysis in which 15 of 149 patients with diffuse alveolar hemorrhage (DAH) underwent NPPE episodes. Moreover, there is one case showed secondary T wave and ST segment dynamic changes, [12] and two cases of secondary acute subendocardial myocardial infarction [11,14] following NPPE, which might also be associated with acidosis and hyperadrenergic response induced by dyspnea. It is implied increasing attention should be paid on the complications secondary to NPPE.…”

International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

“…However, those findings were not confirmed by others. Common in-hospital complications include cardiac arrhythmias, 113 LVOTO, 64 cardiogenic shock, 2 ventricular thrombus, 114 pulmonary oedema, 115 ventricular septal defect, 116 and free wall rupture. 117 In addition, to the demographic parameter of age 75, echocardiographic parameters that predict adverse in-hospital outcome (acute heart failure, cardiogenic shock, and in-hospital mortality) include LVEF, E / e ’ ratio, and reversible moderate to severe MR.…”

Concurrent Negative-Pressure Pulmonary Edema (NPPE) and Takotsubo Syndrome (TTS) after Upper Airway Obstruction

“…It is characterized by apical or midventricular LV dysfunction with new ECG and/or serum cardiac biomarker abnormalities but without obstructive coronary disease and/or plaque rupture by coronary angiography [3]. To our knowledge, these cases represent two of only four total reports of concurrent NPPE and TTS [4, 5]. A number of pathophysiologic mechanisms of TTS have been proposed which typically revolve around a sudden and profound catecholamine release, including catecholamine-induced multivessel epicardial spasm and cyclic AMP-mediated intracellular calcium overload [6, 7].…”