An Atypical Case of Reverse Takotsubo Cardiomyopathy During General Anesthesia in a 30-Year-Old Male With Post-Traumatic Stress Disorder

Abstract

TAKOTSUBO CARDIOMYOPATHY, also referred to as transient left ventricular ballooning syndrome or stress-induced cardiomyopathy, describes a rapid-onset, yet reversible systolic dysfunction that typically is triggered by an acute, stressful event. The pathophysiology is not completely understood, and similar presentations have been described as a result of the endocrine crisis of pheochromocytoma, 1 Iga K. Gen H. Tomonaga G. et al. Reversible left ventricular wall motion impairment caused by pheochromocytoma—A case report. Jpn Circ J. 1989; 53: 813-818 Crossref PubMed Scopus (42) Google Scholar subarachnoid hemorrhage, 2 Pollick C. Cujec B. Parker S. et al. Left ventricular wall motion abnormalities in subarachnoid hemorrhage: An echocardiographic study. J Am Coll Cardiol. 1988; 12: 600-605 Abstract Full Text PDF PubMed Scopus (192) Google Scholar and Guillain-Barré syndrome. 3 Iga K. Himura Y. Izumi C. et al. Reversible left ventricular dysfunction associated with Guillain-Barre syndrome—An expression of catecholamine cardiotoxicity?. Jpn Circ J. 1995; 59: 236-240 Crossref PubMed Scopus (73) Google Scholar A wide heterogeneity of presentation suggests that multiple overlapping mechanisms such as neurogenic catecholamine-induced myocardial stunning, 4 Wittstein I.S. Thiemann D.R. Lima J.A. et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352: 539-548 Crossref PubMed Scopus (2324) Google Scholar microvascular dysfunction, 5 Bybee K.A. Prasad A. Barsness G.W. et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004; 94: 343-346 Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar and multivessel epicardial spasm 6 Dote K. Sato H. Tateishi H. et al. Myocardial stunning due to simultaneous multivessel coronary spasms: A review of 5 cases. J Cardiol. 1991; 21: 203-214 PubMed Google Scholar , 7 Gianni M. Dentali F. Grandi A.M. et al. Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. Eur Heart J. 2006; 27: 1523-1529 Crossref PubMed Scopus (1098) Google Scholar may play a role. Symptoms mimic an ST-segment elevation myocardial infarction. Patients present with ischemic electrocardiographic changes, reduced left ventricular ejection fraction, and a balloon-like contractility pattern that portrays a unique wall-motion abnormality that extends beyond the myocardial territory of a single coronary artery. The classic form presents as transient apical ballooning with basal hypercontractility. In more rare cases of reverse Takotsubo, the opposite is observed—transient dilatation of the basal segments of the heart with hyperkinesis of the apex.