Abstract 13399: A Case of Propofol-Induced Takotsubo Cardiomyopathy

Abstract

Introduction: Takotsubo syndrome (TS) is a transient cardiomyopathy characterized by an apical ballooning appearance, mimicking a myocardial infarction. Stress-induced catecholamine excess is the best studied hypothesis. There have been few reported cases of TS following induction of anesthesia. This is the first case that describes propofol as an inciting factor in the development of TS. Case report: A 75-year old male with history of COPD, recurrent pneumothorax, pharyngeal cancer, and no prior cardiac history, presented with dyspnea. Chest x-ray revealed a right-sided pneumothorax. Plan was to proceed with thoracoscopy and talc pleurodesis. He underwent induction of general anesthesia with propofol. Following induction, he went into asystole, requiring a round of CPR prior to ROSC and transfer to the ICU. Troponin was elevated at 1.12. EKG revealed diffuse ST-segment elevation. ECHO showed EF 15-20%, with severe global hypokinesis, a hyperdynamic left ventricle at the base, concerning for TS (Figure 1). Repeat ECHO eight days later, revealed a recovered EF of 70-75%. The most likely diagnosis was TS. Discussion: This case identifies propofol as an inciting factor in the development of TS during the induction of general anesthesia. Propofol is a sedative-hypnotic, used in the induction and maintenance of general anesthesia. It works by decreasing the dissociation from GABA receptors, leading to an inhibitory effect on wakefulness. However, it also adversely acts at the cellular level as a calcium antagonist, reducing vascular tone, leading to hypotension and depression of myocardial contractility. We postulate that the inhibitory effects of propofol on the cardiovascular system, likely contributed to the development of TS in our patient. Conclusion: In conclusion, use of propofol during the induction process may be an important risk factor in the development of TS. This is an important consideration when choosing induction agents, in high risk patients.