Cardiovascular complications following medical termination of pregnancy: An updated review

Table 2 Patients with takotsubo cardiomyopathy following medical termination of pregnancy

No.	Age, gestation	Clinical feature	TTC criteria: EKG and Trop; echo; coronary angiography negative; pheochromocytoma	Possible pathophysiology	Treatment given	Outcome: Mortality and EF repeat	Ref.
1	36 yr, 12 wk gestation	Misc; hypovolemia	ECG: ST and Trop T elevated; eCHO: TTE (35%) EF, hypok LV apex; coronary angiography: Negative	Catecholamine surge: (1) Direct toxicity; (2) Coronary vasoconstriction; and (3) Microvascular spasm	IV furosemide	5th d repeat echo: LV to EF: 60%. F/u: 11 mo, no relapse	[26]
2	22 yr, gestation: NA	Post Sx TOP with evacuation of retained POC; hypovolemia	EKG: Normal and Trop T elevated; 2D echo: DCM; coronary angiography: Negative	Catecholamine release post procedure	Diuretics. Bisoprolol and lisinopril	Echo: Repeat day 2 had EF 56%. Follow-up, full recovery	[27]
3	37 yr, Misc	Chest pain, radiating to the neck	EKG: ST depression, Trop T elevated; 2D echo: EF < 40%; coronary angiography: Negative	NA	NA	F/u echo EF normal. F/u Trop T normal	[28]
4	43 yr, gestation: NA	Chest pain	EKG: Normal and Trop T elevated; echo: LV hypokinesia, apical, diaphragmal, posterio-basal segments; coronary angiography: Negative	Stress factors: (1) H/o fetal death at 18 wk gestation; and (2) Domestic stress	Beta-blockers, ACE inhibitors, aspirin	5 d later, 2D echo EF 72%, normal wall movements. F/u: Developed 4 episodes of TTC, 6 mo, 9 mo, 10 mo, and 19 mo later. With eventual normalization of EF	[29]
5	43 yr, 9 wk gestation	Post Sx TOP. Shock, hypoxia, cardiac arrest requiring CPR	EKG: T wave inv, Trop T elevated; echo: LV EF 33%, LV apex hypo/akinesia; angiography: NA	h/o autoimmune diseases; post-op stress; cervical infiltration of epinephrine	Infusion of levosimendan	Echo: 3 mo later showed return of the LV function to normal	[30]
6	28 yr, 12 wk gestation	Chest pain	EKG: T wave inv, Trop T elevated; echo: EF (30%-35%); hypokinesia mid ventricular and hyperKinesia apical and basal wall; coronary angiography: Negative	Post abortion depression; suicidal ideation	Carvedilol. Lisinopril spironolactone	F/u echo: NA. Hemodynamically stable on follow-up	[31]
7	32 yr, 10 + 1 wk gestation; Misc	Abdominal pain, vaginal bleeding. Later underwent POC evacuation	EKG: Intermittent VT and QRS broadening. Trop T: NA; TTE: EF: 32%, global LV hypokinesia and akinesia of inferior and inferioseptal wall; coronary angiogra gestation phy: Negative	Septic miscarriage with blood C/S: Group C Streptococcus; amphetamine usage	IV antibiotics	Full recovery in 6 wk. 2D echo: Normal on repeat	[32]

Misc: Miscarriage; POC: Product of conception; Sx TOP: Surgical termination of pregnancy; CPR: Cardiopulmonary resuscitation; ST: Sinus tachycardia; DCM: Dilated cardiomyopathy; VT: Ventricular tachycardia; Post-op: Post-operation; EF: Ejection fraction; LV: Left ventricle; TTC: Takotsubo cardiomyopathy; TTE: Transthoracic echocardiography; NA: Not available; EKG: Electrocardiogram; C/S: Culture and susceptibility; F/u: Follow-up.