Clinical case of a patient at risk of perioperative recurrence of takotsubo cardiomyopathy

Abstract

Introduction. Takotsubo syndrome is a new nosological form of acquired cardiomyopathy characterized by transient left ventricular dysfunction in response to physical or psychoemotional stress, clinically and electrocardiographically resembling acute coronary syndrome. Takotsubo cardiomyopathy is a form of stress cardiomyopathy simulating acute myocardial infarction with electrocardiographic and biochemical changes. Despite a large number of publications, there is no definitive understanding of the etiopathogenesis, clinical picture, treatment, as well as measures to prevent the development of takotsubo cardiomyopathy. With the manifestation of takotsubo cardiomyopathy in the perioperative period, the clinical picture may be even less specific, which inevitably leads to diagnostic difficulties. Given that the main trigger of the disease is stress, the development of this disease is an urgent problem of anesthesiology and intensive care. In addition, there is a problem of managing patients with a history of takotsubo cardiopathy, if they need surgical interventions.The aim of the work was to prove the effectiveness of a number of approaches (premedication with the use of barbiturates and α2-adrenoceptor agonists; monitoring the depth of anesthesia; administration of narcotic analgesics in continuous infusion; use of local anesthetics for skin anesthesia; multimodal anesthesia in the postoperative period) to the perioperative management of patients with a high risk of CT recurrence.Materials and method. We present a clinical case demonstrating the possible tactics of perioperative management of a patient with a history of CT that manifested during anesthesia when a follow-up benefit was needed. The clinical picture is described, the results of instrumental and laboratory investigations indicating a correct CT diagnosis are presented.Results. An individual strategy for perioperative management of the patient was developed and implemented, which made it possible to avoid a CT recurrence. Discussion. The etiopathogenesis of the disease and analysis of the few literature sources on the topic allow us to propose a number of approaches to the perioperative management of patients at risk of recurrence of CT.Conclusions. A number of approaches (premedication with barbiturates and α 2-adrenoceptor agonists; anesthesia depth monitoring; administration of narcotic analgesics in continuous infusion mode; use of local anesthetics for skin anesthesia; multimodal anesthesia in the postoperative period) to perioperative management of patients with high risk of CT recurrence were demonstrated to be successful.