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Case Reports
. 2022 Feb;26(2):228-230.
doi: 10.5005/jp-journals-10071-24118.

Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan

Anis Ghariani  1 , Leila Dhiab  2 , Fehmi Ferhi  3 , Mohamed Ab Abdessalem  4 , Abdallah Mahdhaoui  4 , Khaled B Jazia  3 , Gouider Jeridi  2
Affiliations
Case Reports

Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan

Anis Ghariani et al. Indian J Crit Care Med. 2022 Feb.

Abstract

Background: Takotsubo syndrome is a transient stunned myocardium that typically involves the apical and mid-ventricular segments. A variant, called Inverted Takotsubo, concerns the basal and mid-ventricular segments.

Case summary: We present a ruptured ectopic pregnancy that was responsible for a catecholamine surge, which led to this stress-induced cardiomyopathy. Transthoracic echocardiography showed mid-basal segments akinesia and hypercontractility of the apical segments. Biology has shown mild elevated troponin and NT-pro-BNP levels which led to performing a coronary angiography that showed no angiographic stenosis. A left ventricle angiography evoked the diagnosis of inverted Takotsubo. The patient has received Levosimendan to allow progressive weaning of catecholamine inotropes. The clinical evolution was favorable. Echocardiography performed after 3 weeks, showed ad-integrum restitution of the left ventricular function.

Discussion: Takotsubo syndrome should be evoked whenever a context of physical or psychological stress is present. We underline the usefulness of Levosimendan as a nonadrenergic inotrope in this particular context.

How to cite this article: Ghariani A, Dhiab L, Ferhi F, Abdessalem MAB, Mahdhaoui A, Jazia KB, et al. Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan. Indian J Crit Care Med 2022;26(2):228-230.

Keywords: Echocardiography; Ectopic pregnancy; Heart failure; Levosimendan.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A and B
Figs 1A and B
Left ventricular angiography that shows mid-basal segments akinesia and hypercontractility of the apical segments
Figs 2A and B
Figs 2A and B
Tranthoracic echocardiography 7 days after admission. (A) It shows an improvement of left ventricular systolic function with ejection fraction estimated at 50%; (B) Global longitudinal strain calculated at −14.0%
See this image and copyright information in PMC

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