Stress ‘Takotsubo’ Cardiomyopathy in a Postoperative Pre-menopausal Woman

Abstract

A 48-years-old, pre-menopausal lady, with no co-morbidities underwent elective surgery. While recovering in postoperative intensive care unit, she developed chest pain and breathing difficulty. Auscultation revealed bilateral basal crepitations and an S3gallop. 12 lead electrocardiogram (ECG) showed T inversion in the precordial chest leads and QT prolongation. Her cardiac enzymes were elevated. A bedside echocardiogram revealed, hypercontactile basal segments and apical dyskinesis, a global ejection fraction of 40%. She underwent emergency coronary angiogram (CAG) which revealed normal epicardial coronaries. Left ventriculography revealed systolic apical ballooning and hypercontractile basal segments with impaired LV systolic function (LVSF). With aggressive medical therapy, the patient’s symptoms improved. Left ventriculography after 10 days showed normalization of the systolic apical ballooning and the LVSF. When questioned, subsequently, the patient revealed that she had recently experienced severe emotional stress due to financial instability.

Keywords

• Stress Cardiomyopathy
• Postoperative
• Premenopausal woman