Abstract
The authors'patient underwentsurgicalstimulus,possible CO2 embolus, andsufferedhemodynamiccollapsewithsub-sequent resuscitationincludingbolusdosingofepinephrine.These factorslikelycontributedtodevelopmentofTakotsubo cardiomyopathy. Theircaseemphasizespractitionercognizance of Takotsubocardiomyopathyasacauseofacute,decom- pensated leftventricularfailure,especiallyinpatientswitha history ofpheochromocytoma.Totheauthors' knowledge, there hasbeennoreportofTakotsuboinpatientspost-resection of apheochromocytomaorparaganglioma.Thecasesuggests patients whohavehadsustainedcatecholamineexposuremay be predisposedtoTakotsuboevenyearsafterpresumed curative procedures.Thistopicmeritsfurtherinvestigation.The patientdiddemonstrateelevationinplasmacatechol-amines andelevatedbloodpressures,possiblyindicating continued increasesinsympathetictone,againconceivably increasing theriskfordevelopmentofTakotsubo.Whilethere are insufficient datatosuggestchangestostandardpreoperative cardiac evaluationinthesepatients,adetailedpreoperaive history andphysicalexaminationfocusedonthecardiacsystem should bethestandard,withalowthresholdforfurther diagnostics. Earlyechocardiographyandcatheter-basedevalu-ation shouldbeusedtoassesspersistentcardiovascular instability ifTakotsuboissuspected.Anearlyinitiationof LV mechanicalassistdevicesalsoshouldbeconsidered. Finally, whileIVepinephrinewasgivenappropriatelyin response toPEAintheauthors' patient, IVvasopressinmay be ausefulalternativetoepinephrineduringresuscitationof patients withsuspectedTakotsubocardiomyopathy.
Original language | English (US) |
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Pages (from-to) | 1596-1598 |
Number of pages | 3 |
Journal | Journal of Cardiothoracic and Vascular Anesthesia |
Volume | 29 |
Issue number | 6 |
DOIs | |
State | Published - Dec 1 2015 |
Keywords
- Takotsubo
- epinephrine
- intraoperative
- pheochromocytoma
- stress-induced cardiomyopathy
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Anesthesiology and Pain Medicine