Takotsubo (Stress) Cardiomyopathy and the Anesthesiologist: Enough Case Reports. Let's Try to Answer Some Specific Questions!

Abstract

Takotsubo cardiomyopathy (also known as takotsubo syndrome, broken heart syndrome, ampulla cardiomyopathy, transient left ventricular apical ballooning, apical ballooning syndrome, transient left ventricular dysfunction syndrome, and stress [induced] cardiomyopathy) was first described in Japan in 1990. 1 ** It was initially characterized by a unique pattern of transient (hours to weeks) wall motion abnormality (“transient left ventricular apical ballooning”) occurring in the absence of significant epicardial coronary artery disease, presenting as an acute coronary syndrome, most frequently in postmenopausal elderly women, often triggered by stressful situations. It has since been observed throughout the world and under various circumstances.†† This condition was first described in the perioperative period in the North American anesthesia literature via case reports that appeared in the September 2006 issues of Anesthesia & Analgesia 4 and Anesthesiology. 5 Since that time, multiple case reports of periprocedural (e.g., endoscopy, catheterization, and electroconvulsive therapy) and at least 25 to 38 perioperative cases of takotsubo cardiomyopathy have appeared 6–23 with the latest in this issue of Anesthesia & Analgesia. 24,25 Anesthesiologists may also confront this syndrome while caring for patients with aneurysmal subarachnoid hemorrhage (A-SAH), 26–29 pheochromocytoma, 30–37 and other critical illnesses. 3,38,39 In this issue of Anesthesia & Analgesia, Daly and Dixon 24 report on 2 cases of takotsubo cardiomyopathy that occurred in an elderly (76- and 78-year-old) man and woman,