Case Report: Takotsubo syndrome in a postoperative patient without cardiological disease

Abstract

Background: Takotsubo syndrome (TS) is characterized by a clinical presentation that mimics acute coronary syndrome but is reversible. Alterations of Takotsubo in patients without previous heart disease remain a challenge for diagnosis. Case report: We present a case of an 80-year-old patient from Peru. The patient underwent surgery, with the diagnosis of Chilaiditi’s syndrome. One day after surgery, she presented with dyspnea, tachycardia, and electrocardiographic changes (paroxysmal atrial fibrillation and infrequent ventricular extrasystoles without abnormalities in the ST-segment). The diagnosis of Takotsubo syndrome with cardiogenic shock was made. She was hospitalized in the Intensive Care Unit and was managed with vasopressors and nitroglycerin. There was no cardiac lesion in the cineangiogram or occlusion of arteries. The patient was extubated and received daily dialysis until discharge. Conclusions: Takotsubo is an emotional, non-cardiac, or post-traumatic stressful event that triggers myocardial injury with segmental anomalous, the possible etiology of which is the release of an endothelial neurotransmitter caused by stress. Emergency physicians should be aware of this as even patients without previous cardiac pathologies when exposed to stressors (such as surgeries) develop emergency symptomatology similar to myocardial infarction. Thus, emergency physicians should identify any cardiac abnormalities after a stressor, as well as be prepared for the diagnosis of TS.