Background: Takotsubo Cardiomyopathy (TC) was first reported in 1990 by Sato et al and Doron Gavish et al were the first publishing an anesthesia associated takotsubo case1,4. It was named after an octopus fishing pot (Takotsubo) because of it’s appearance on the left ventriculography2,3.
TC is rare, mimics an acute coronary syndrome and results in a reversible acute left ventricular dysfunction in the absence of obstructive coronary disease.1,2,3 It is more common in postmenopausal women, although it can also affect young men.1 The prognosis is favorable, showing low complication rates and intra-hospitalar mortality and a recurrence of 10%. Nevertheless, serious complications as cardiac arrest can occur.
Case Report: We are reporting a case of a 66 years old male without relevant past medical history, that presented for an elective inguinal herniorrhaphy. Preoperative evaluation with no significant findings, besides a high level of anxiety. On the anesthesia emergence he showed hemodynamic instability, followed by cardiac arrest. The ECG performed was compatible with an acute myocardial infarction. He presented with associated raised cardiac enzymes, normal coronary angiography and abnormal ventriculography showing severe depression of systolic function and typical motility changes of TC.
Discussion: The described case, reporting a left ventricular dysfunction with an ECG suggesting acute coronary syndrome associated with a cardiogenic shock, is compatible with the diagnose of TC. Despite of the fact that the patient doesn’t fit in the common profile of this syndrome (female, post-menopause), this case gathers all the diagnostics criteria and typical evolution of the TC: emotional and physical stress, cardiac markers and ECG suggestive of ACS, normal coronary angiography, image feature on ventriculography, severe early ventricular dysfunction with rapid recovery, good evolution and no recurrence.
Learning Points: The number of reports of MT is relatively small and its pathophysiology, treatment and prognosis aren’t well understood. 6 There is a direct correlation between physiologic stress and cardiovascular events from the anesthetic induction until the 4th post-operative day.¹ This case describes the occurrence of a TC during general anesthesia, namely during anesthetic emergency, and highlights the importance of a crucial early diagnosis.

Takotsubo cardiomyopathy associated with anesthesia - a case report