Abstract
Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction in the absence of atherosclerotic disease. A 63yr old female with multiple autoimmune disorders was admitted to intensive care unit with severe hypotension and hypoxic respiratory failure following total thyroidectomy. During her evaluation, her 2D echocardiogram showed good basal contractions with severe mid and apical hypokinesia and an ejection fraction of 35%. Her coronary angiogram showed normal epicardial coronaries and evidence of apical ballooning suggestive of TCM. Its recognition is important for prognostic evaluation and treatment considerations. Furthermore, the relationship between autoimmunity and TCM needs to be evaluated further.
Highlights
Takotsubo cardiomyopathy (TCM) is a wellknown but an under-diagnosed disease characterized by transient left ventricular dysfunction in the absence of atherosclerotic disease
We report a case of TCM during immediate postoperative period which made a dilemma, mimicking an acute coronary event
Gianni and colleagues showed TCM is more common among post-menopausal females, which thought to be due to altered endothelial functions due to lack of oestrogen.[4]
Summary
Takotsubo cardiomyopathy (TCM) is a wellknown but an under-diagnosed disease characterized by transient left ventricular dysfunction in the absence of atherosclerotic disease. Case history A 63yr old ASA 2 lady was admitted to the surgical intensive care unit due to respiratory failure and hypotension following thyroidectomy She had type 2 diabetes, autoimmune haemolytic anaemia (IgG), autoimmune thyroiditis and vitamin B12 deficiency. The ECG changes and positive troponin suggested, hypotension was of cardiac origin She was ventilated on pressure controlled mode with positive end expiratory pressure (PEEP) of 1012cmH2O. Based on the abnormal ECG changes, non-occlusive coronary arteries, mild elevation of cardiac markers, and apical left ventricular systolic dysfunction, the diagnosis of TCM was made. She was transferred to coronary care unit and inotropes and vasopressors were gradually tailed off. After the 3rd day her ECG became normal and 2D ECHO showed normal left ventricular function
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