The use of point of care ultrasonography in the perioperative period: A case of Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy is a stress induced, transient cardiomyopathy that commonly presents with regional left ventricular akinesis or hypokinesis. The perioperative incidence of Takotsubo is estimated at 1:6700 cases and as such, should be familiar to practicing anesthesiologists. Point of care ultrasonography is a valuable tool for the evaluation of cardiac function and can be utilized in the perioperative setting by anesthesia staff. With some basic training in ultrasonography, one can quickly assess volume status and cardiac function, among other things. We present the case of a 73-year-old male undergoing an elective rotator cuff repair with an interscalene block under general anesthesia. Immediately following induction, the patient had a pulseless electrical activity arrest. Following immediate resuscitation, point of care ultrasonography was used to delineate the cause of the arrest and guide immediate management. Features consistent with Takotsubo cardiomyopathy – including regional left ventricular wall motion abnormalities with associated low ejection fraction – were identified on early ultrasound. The patient made a successful recovery and repeat cardiac imaging showed resolution of the wall motion abnormalities.