Case report of Tako-Tsubo cardiomyopathy associated with repetitive anaesthesia in a female patient with Tako-Tsubo cardiomyopathy

Abstract

Background: Tako-Tsubo cardiomyopathy (TTC) is a rare disorder with high relevance for anaesthesia. It is an acute cardiac syndrome characterized by an acute onset of reversible left ventricular dysfunction associated with emotional and physical stress. This is the only case published of a patient having five severe Tako-Tsubo incidents in five consecutive general anaesthesia procedures within one year.

Case presentation: A 61 years old female patient (height 1.65 m; weight 70 kg) presented with a haemorrhagic pituitary adenoma with compression of the optic chiasm and was scheduled for transnasal endoscopic tumour resection. We report a case series with five consecutive anaesthesia procedures in the same patient for neurosurgery. This case series is remarkable since the severe symptoms occurred during every anaesthesia procedure. The female patient was resuscitated two times including therapeutic hypothermia, but fortunately no neurological or cognitive deficit was detectable.

Conclusions: TTC may initially present in the perioperative period with pulmonary oedema, electrocardiographic (ECG) changes, elevation of cardiac enzymes, and cardiogenic shock or cardiac arrest. Since the risk of recurrence is considered to be low in TTC, this case report is of high interest. In each procedure similar clinical signs were found which resulted in severe haemodynamic derangements in every manifestation and cardiac arrest in two of the manifestations. Despite cardiopulmonary resuscitation twice, the patient survived without any neurological deficiency.

Keywords: Ampulla cardiomyopathy; Broken heart syndrome; Stress-induced cardiomyopathy; Tako-Tsubo cardiomyopathy; Transient left-ventricular apical ballooning syndrome.

Figure 1

Normal heart (A) and Tako-Tsubo sign (B) with apical ballooning (end-systolic view).

Figure 2

Resting ECG of the patient.

Figure 3

Original case TEE sequence in anaesthesia #4. A. acute onset of left ventricular dysfunction/considerable hypokinesia (reduced contractility: outer circle: diastole; inner circle: systole). B. after successful therapeutic intervention: normal left ventricular function/no considerable wall motion abnormalities (normal contractility: outer circle: diastole; inner circle: systole).