Takotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation

Background Takotsubo cardiomyopathy (TCM) can clinically present as an acute coronary syndrome; however, the former has regional wall motion abnormalities that extend beyond a single coronary vascular territory without any plaque rupture. Takotsubo cardiomyopathy classically involves apical ballooning of left ventricle (LV). It is uncommon for TCM to present as cardiopulmonary arrest (CPA) along with third-degree atrioventricular (AV) block. Case summary A 63-year-old female, underwent a ventricular fibrillation (VF) CPA. She was defibrillated three times and return of spontaneous circulation (ROSC) was achieved after 37 min. Her post-ROSC electrocardiogram showed non-specific ST-segment changes and T-wave inversions and soon progressed to third-degree AV block. Patient had a transvenous pacemaker placed to pace her heart. Echocardiogram showed an LV ejection fraction of 15–20% with akinesis of the apex and anteroseptum. An echocardiogram repeated 4 days after the cardiopulmonary arrests showed an ejection fraction of 60–65% with hypokinesis of mid anterior and antero-apical hypokinesis. However, the patient still continued to require a pacemaker and hence eventually received a dual-chamber pacemaker/implantable cardioverter-defibrillator for her AV block and ventricular arrhythmia. Discussion Most commonly TCM presents with chest pain and symptoms of acute myocardial infarction. We present a very rare presentation of TCM associated with VF and CPA along with third-degree AV block. There have handful of case reports documenting TCM causing CPA in some patients and other case reports showing TCM causing high degree AV block. In our patient, TCM was associated with both VF and CPA along with third-degree AV block.

show abstract

“… 10 However, arrhythmias including atrial fibrillation, AV block, and asystole are very rare. 11 …”

Section: Discussionmentioning

confidence: 99%

An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

Parekh

Sengupta

Zainea

2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

show abstract

“…Although TTS is often described as having a transient clinical course, it is associated with substantial morbidity and mortality 2 . During the acute phase, TTS patients can present with hemodynamic and electrical instability due to cardiogenic shock, ventricular arrhythmias, heart failure, pulmonary edema and are at increased risk of cardiac death 1,3–5 . Life‐saving invasive interventions such as intra‐aortic balloon pump, ventricular assist devices, and extracorporeal membrane oxygenation are often required to mitigate the serious complications 6,7 …”

Section: Introductionmentioning

confidence: 99%

Takotsubo syndrome after liver transplantation: An association with intraoperatively administered epinephrine and fentanyl

Yang

Rao

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

Takotsubo syndrome (TTS) can develop after liver transplant (LT), but its predisposing factors are poorly understood. In this study, we aimed to determine if perioperative factors were associated with posttransplant TTS. Adult patients who underwent primary LT between 2006 and 2018 were included. Patients with and without TTS were identified and matched by propensity scores. Of 2181 LT patients, 38 developed postoperative TTS with a mean left ventricular ejection fraction of 25.5% (±7.8%). Multivariable logistic regression revealed two preoperative risk factors (alcoholic cirrhosis and model for end-stage liver disease-sodium scores) for TTS. Post-propensity match analyses showed that TTS patients had significantly higher doses of epinephrine and lower doses of fentanyl during LT compared with non-TTS patients. A higher dose of epinephrine and a lower dose of fentanyl was associated with a higher predicted probability of TTS. All TTS patients had full recovery of cardiac function and had comparable 1-year survival. In conclusion, TTS occurred at a rate of 1.7% after LT and was associated with two pretransplant risk factors. The higher doses of epinephrine and lower doses of fentanyl administered during LT were associated with posttransplant TTS. More studies on the relationship between intraoperative medications and TTS are warranted.

show abstract

“…Only about 2 dozen cases of TS occurring in the perioperative or intraoperative phases of a LT have been reported to date [1]. Case reports of TS in LT patients include 1 patient requiring a left ventricular assist device (LVAD) after failing inotropic and vasopressor therapy [7], patients who had a cardiac arrest due to TS [8,9], and another patient who experienced TS intraoperatively during the anhepatic stage of liver transplant [10].…”

Section: Introductionmentioning

confidence: 99%

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation – Which Came First?

et al. 2020

View full text Add to dashboard Cite

Rare co-existance of disease or pathology Background: Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. Case Report: The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. Conclusions: It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.

show abstract

Takotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation

Cited by 5 publications

References 16 publications

An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

Takotsubo syndrome after liver transplantation: An association with intraoperatively administered epinephrine and fentanyl

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation – Which Came First?

Contact Info

Product

Resources

About