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Review
. 2024 Jul 15;4(1):45.
doi: 10.1186/s44158-024-00178-y.

Perioperative management of Takotsubo cardiomyopathy: an overview

Marta Pillitteri  1 , Etrusca Brogi  2 , Chiara Piagnani  1 , Giuseppe Bozzetti  3 , Francesco Forfori  1
Affiliations
Review

Perioperative management of Takotsubo cardiomyopathy: an overview

Marta Pillitteri et al. J Anesth Analg Crit Care. .

Abstract

Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.

Keywords: Broken heart syndrome; General anaesthesia; Left ventricular apical ballooning syndrome; Perioperative period; Stress cardiomyopathy; Takotsubo cardiomyopathy; Takotsubo syndrome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pathophysiological of Takotsubo syndrome
Fig. 2
Fig. 2
Possible electrocardiographic alterations observed in Takotsubo syndrome
Fig. 3
Fig. 3
Subsequential echocardiographic 3D images of ejection fraction of a typical form of TTS
Fig. 4
Fig. 4
Systolic longitudinal strain pattern of a typical form of TTS: total lack of shortening of the myocardial apical segments (blue colour), indicating loss of contractility, and normal shortening pattern of the basal areas (red colour)
Fig. 5
Fig. 5
Flowchart of TTS management
Fig. 6
Fig. 6
Treatment strategy based on the type of surgery; elective vs emergent
See this image and copyright information in PMC

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