Takotsubo syndrome after a minimally invasive tooth extraction in a patient without dental phobia: A case report

Abstract

Takotsubo syndrome (TTS) is a rare, stress‐induced acute cardiac disorder. Its precipitating factors include emotionally or physically stressful events and exogenous and endogenous adrenaline. In this report, we describe a case of atypical TTS in a 73‐year‐old woman who reported no dental fear and required acute cardiac care in an outpatient setting. She underwent routine extraction of an upper left premolar under local anesthesia. She reported heart palpitations after the injection, and the procedure was completed in 15 min. After presenting symptoms of sweating, pale skin, vomiting, low blood pressure, and ST‐segment elevation, cardiologists ordered echocardiography, coronary angiography, and ventriculography. Upon receiving a TTS diagnosis, the patient was hospitalized and administered an intra‐aortic balloon pump and beta‐blocker. Her symptoms resolved, and she was discharged with no sequelae. We found no precipitating factors in the progression of TTS in this case, which suggests that TTS can develop in the absence of precipitating factors. All general dentists and oral surgeons should recognize the possible risk of TTS, even during minimally invasive dental procedures, such as routine extractions in patients without dental phobia.

Reply to the letter to the editor by Finsterer et al. titled “Before blaming the tooth extraction, consider alternative triggers of Takotsubo”

“…Additionally, we directly obtained the patient's medical history via interview, and there was no history of cardiomyopathy, autonomic dysreflexia, or neuromuscular disorders. Furthermore, as noted in our original article, 4 the patient did not fear dental treatment, and she had previously received dental treatment without problems; therefore, psychological stress was unlikely to be involved.…”

Before blaming the tooth extraction for the TTS, consider alternative triggers

“…We eagerly read the article by Takuma et al about a 73 years old female (height 148 cm, weight 43.6 kg) who developed Takotsubo syndrome (TSS) shortly after extraction of a left upper premolar under local anesthesia with lidocaine/adrenaline. 1 TTS resolved upon application of an intra-aortic balloon pump and application of bisoprolol. 1 The study is appealing but raises concerns which require discussion.…”

“…1 TTS resolved upon application of an intra-aortic balloon pump and application of bisoprolol. 1 The study is appealing but raises concerns which require discussion.…”

“…5 We disagree with the information that the patient had only mixed connective tissue disease and osteoporosis in her previous history. 1 Since the patient was also taking mecobalamin, she also had vitamin B12-deficiency. Since she was also taking rebamipide, she presumably also had gastritis or gastric or duodenal ulcer.…”

When a Tooth Pulls the Heart Strings: Takotsubo Cardiomyopathy Post-dental Extraction

“…Although the link between stresses, including emotional trauma, serious sickness, and surgical procedures and the development of takotsubo cardiomyopathy has been well-documented, it is still extremely uncommon and underreported in the literature [ 5 , 6 ].…”