The Sudden Death of a Pregnant Woman With Takotsubo Cardiomyopathy Following a Legal Abortion: A Case Report

Abstract

Background: Takotsubo cardiomyopathy (TCM) is characterized by left ventricular dysfunction and apical ballooning due to physical or mental stress in the absence of coronary artery disease. This transient heart disorder is rare in pregnancy. It may affect women of reproductive age. Case Presentation: The case was a 38-year-old woman in the first trimester of pregnancy with a history of TCM diagnosis one year ago, admitted to the hospital for a legal abortion. At the time of hospitalization, echo cardiography, echo cardiography, and clinical tests results were normal; however, due to stressful factors, such as the cancellation of the dilation & curettage (D&C) procedure, despite being transferred to the operating room (due to the absence of a gynecologist), receiving misoprostol for two consecutive days, the prolongation of surgery time, as well as the absence of a psychiatrist to reduce stress during the operation, suffered from recurrent TCM and eventually expired. In the autopsy, the cause of death was a massive pulmonary embolism. Conclusion: In pregnant women, there is a possibility of TCM recurrence due to changes in hormonal levels and emotional and physical stress caused by pregnancy. Therefore, when performing a surgical procedure such as D&C, a team consisting of gynecologists, cardiologists, and psychiatrists should be present to avoid dangerous complications such as sudden death.