Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section

• Published in: Journal of anesthesia 2014-02, Vol.28 (1), p.121-124
• Main Authors: Suzuki, Tsuyoshi, Nemoto, Chiaki, Ikegami, Yukihiro, Yokokawa, Tetsuro, Tsukada, Yasuhiko, Abe, Yoshinobu, Shimada, Jiro, Takeishi, Yasuchika, Tase, Choichiro
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia, General - methods; Anesthesiology; Cardiomyopathy; Care and treatment; Case studies; Causes of; Cesarean Section; Clinical Report; Critical Care Medicine; Diagnosis; Echocardiography; Emergency Medicine; Female; Heart diseases; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Intensive; Medicine; Medicine & Public Health; Pain Medicine; Pregnancy; Pulmonary edema; Pulmonary Edema - etiology; Pulmonary Edema - physiopathology; Takotsubo Cardiomyopathy - etiology; Takotsubo Cardiomyopathy - physiopathology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-013-1677-6

Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.