• ecmo
• heart failure
• intestine transplant
• left ventricular systolic dysfunction
• liver transplant
• multiorgan transplant
• multivisceral transplant
• stress cardiomyopathy
• takotsubo cardiomyopathy
• venovenous bypass

• Angina
• Cardiac arrest
• Case report
• Percutaneous coronary intervention
• Takotsubo syndrome

• Takotsubo Cardiomyopathy/epidemiology
• Takotsubo Cardiomyopathy/etiology
• Humans
• Liver Transplantation/adverse effects
• Prevalence
• Female
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• India/epidemiology

• Takotsubo cardiomyopathy
• heart transplantation
• kidney transplantation
• liver transplantation
• lung transplantation
• postoperative complications

• Atrial function
• Cardiac magnetic resonance
• Female
• Takotsubo cardiomyopathy
• Ventricular function

• Humans
• Female
• Middle Aged
• Male
• Heart Ventricles
• Takotsubo Cardiomyopathy/diagnostic imaging
• Takotsubo Cardiomyopathy/pathology
• Retrospective Studies
• Convalescence
• Magnetic Resonance Imaging, Cine/methods
• Heart Atria/diagnostic imaging
• Heart Atria/pathology

• Middle Aged
• Humans
• Female
• Aged
• Electroconvulsive Therapy/adverse effects
• Takotsubo Cardiomyopathy/etiology
• Takotsubo Cardiomyopathy/therapy
• Shock, Cardiogenic/complications

• cardiac stressor
• hypokinesis
• shark fin
• st-segment elevation myocardial infarction (stemi)
• takotsubo cardiomyopathy (ttc)

• anesthetic management
• epilepsy
• takotsubo cardiomyopathy

• Female
• Humans
• Aged
• Takotsubo Cardiomyopathy/diagnosis
• Takotsubo Cardiomyopathy/etiology
• Heart Ventricles
• Cardiomyopathies/complications
• Epilepsy/surgery
• Epilepsy/complications
• Anesthetics

• atrial natriuretic peptides
• high-sensitive cardiac troponin I
• juvenile cat
• neutering surgery
• perioperative myocardial injury

• Caesarean section
• Haemoglobin
• Leucocyte
• Nested case-control study
• Peri-operative Takotsubo syndrome
• Revised cardiac risk index

Takotsubo cardiomyopathy (TC) is a rare disease with unclear etiology that is characterized by wall motion abnormalities of the left ventricle. We report a 64-year-old woman who presented with cardiac arrest 6 hours after ureteral stenting, with no history of heart disease. Notably, she had a urinary tract infection preoperatively. TC was diagnosed with characteristic apical ballooning on the left ventriculogram. The hemodynamics and cardiac function recovered quickly within 1 day after conservative treatment and controlling the infection. TC should be considered when a patient presents with decreased cardiac function after ureteral stenting, especially in patients with potential concurrent infection. A review of the literature documenting cases of TC related to urological surgery in the past decade was conducted using PubMed. The results were summarized in a table.

• Takotsubo cardiomyopathy
• apical ballooning syndrome
• cardiac arrest
• conservative therapy
• ureteral stenting
• urinary tract infection
• urologic surgery
• ventricle

Critically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized.

To describe a case series of patients with SC admitted to critical care units.

We conducted a retrospective observational study at a tertiary care teaching hospital. All adult (≥ 18 years old) patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.

Of 24279 admissions to the critical care units [19139 to medical-surgical intensive care units (MSICUs) and 5140 in coronary care units (CCUs)], 109 patients with SC were identified. Sixty (55%) were admitted to the coronary care units (CCUs) and forty-nine (45%) to the medical-surgical units (MSICUs). The overall incidence of SC was 0.44%, incidence in CCU and MSICU was 1.16% and 0.25% respectively. Sixty-two (57%) had confirmed SC and underwent cardiac catheterization whereas 47 (43%) had clinical SC, and did not undergo cardiac catheterization. Forty-three (72%) patients in the CCUs were diagnosed with primary SC, whereas all (100%) patients in MSICUs developed secondary SC. Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine (59%) MSICU patients. There were no statistically significant differences in intensive care unit (ICU) mortality, in-hospital mortality, use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.

Stress cardiomyopathy can be under-recognized in the critical care setting. Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure in ICU.

• Stress cardiomyopathy
• Critical care
• Shock
• Respiratory failure

• Cardiomyopathy
• Perioperative
• Takotsubo syndrome

• Broken heart syndrome
• Cardiac MRI
• Echocardiogram
• Stress cardiomyopathy
• Takotsubo cardiomyopathy

• Takotsubo cardiomyopathy
• pericardiectomy

• anesthesia, local
• epinephrine
• heart failure
• intraoperative complications
• lidocaine
• takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a rare but life-threatening condition that is still not completely understood. Characterised by rapidly reversible ventricular dysfunction without any prior coronary artery disease, it can imitate a myocardial infarction and lead to death if not managed appropriately. This report examines a case of intraoperative cardiac arrest in a patient with no previous cardiac disease, and discusses the factors that may have precipitated this event, as well as the ways of distinguishing the cause of the arrest based on clinical course and investigations, eventually leading to a diagnosis of TTC.

• anaesthesia
• cardiovascular medicine
• heart failure
• surgery

• Cardiac magnetic resonance imaging
• Nitrosative stress
• Takotsubo syndrome
• β2-adrenoceptor signalling

• heart failure
• liver transplant
• mechanical circulatory support
• perioperative management
• predictors

Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease that may be triggered by an acute medical illness or intense physical or emotional stress. TCM is often confused with acute myocardial infarction given the similar electrocardiographic changes, cardiac enzymes, hemodynamic perturbations, and myocardial wall motion abnormalities. In the perioperative setting, the clinical picture may be more confusing because of the effect of anesthesia as well as hemodynamic changes related to the surgery itself. However, awareness of various other diagnostic modalities may enable clinicians to distinguish between the two, more systematically and with greater certainty. Despite the large body of literature, there still seems to be an overall paucity in our understanding of the etiopathogenesis, clinical characteristics, natural history, and management of this syndrome, especially in the perioperative setting. This narrative review seeks to present and synthesize the most recent literature on TCM and to identify gaps in current knowledge which can become the basis for future research.

• Perioperative
• stress
• surgery
• takotsubo cardiomyopathy

• cardiovascular
• general physiology
• intensive care
• neuro‐anaesthesia

• Age
• Females
• Males
• Takotsubo syndrome
• Trigger factors

• Adult
• Age Factors
• Aged
• Central Nervous System/physiopathology
• Drug-Related Side Effects and Adverse Reactions
• Emotions
• Female
• Humans
• Male
• Middle Aged
• Sex Factors
• Surgical Procedures, Operative/adverse effects
• Takotsubo Cardiomyopathy/etiology

Takotsubo cardiomyopathy (TCM) is a reversible acute cardiac disease that mimics acute myocardial infarction (AMI). In patients with a history of an old myocardial infarction who develop TCM, cardiac magnetic resonance imaging (CMRI) is the first-line non-invasive diagnostic tool for clearly discriminating between AMI and TCM.

A 65-year-old woman who suffered a myocardial infarction in 2012, was admitted to undergo sigmoid colon tumour surgery in January 2017. Soon after surgery, she developed angina associated with ST-segment elevation, as shown by electrocardiography and increased cardiac enzyme levels. Acute coronary syndrome was diagnosed. She had a good clinical response to treatment with intravenous nitroglycerine, opioids, clopidogrel, aspirin, bisoprolol, and atorvastatin. Transthoracic echocardiography (TTE) showed anteroseptal and apical left ventricular akinesia with balloon-like dilatation, akinesia of the inferior wall and inferior interventricular septum, and global systolic dysfunction. Coronary angiography did not identify coronary artery lesions, and a tentative diagnosis of TCM was made. Cardiac magnetic resonance imaging confirmed the segmental contraction abnormalities seen in the TTE and identified myocardial oedema without delayed hyperenhancement after gadolinium administration, which confirmed the diagnosis of TCM and ruled out acute ischaemic damage. She was discharged when asymptomatic. Cardiac magnetic resonance imaging at 2 months showed disappearance of the anteroseptal and apical contraction abnormality, regression of myocardial oedema and normalization of global left ventricular systolic function.

This case confirms that CMRI is a non-invasive diagnostic method for accurately differentiating between AMI and TCM in patients with a prior myocardial infarction. cardiac magnetic resonance imaging should be incorporated as a diagnostic criterion for TCM.

• Acute myocardial infarction
• Cardiac magnetic resonance
• Case report
• Takotsubo cardiomyopathy
• Takotsubo syndrome

Simultaneous occurrence of transient global amnesia and Takotsubo syndrome has been only rarely reported. Here we report another patient with a transient global amnesia and concomitant Takotsubo syndrome.

Our patient is a 64-year-old white man with a previous history of myocarditis from borreliosis who developed sudden-onset confusional state with perseverations and repetition of the same questions during a funeral for his brother-in-law. Upon neurological work-up and after spontaneous resolution of most of the neurological deficits, transient global amnesia was diagnosed. Blood tests revealed moderate renal insufficiency, elevated troponin-T, and elevated N-terminal prohormone of brain natriuretic peptide. Electrocardiography showed left anterior hemiblock and negative T-waves in V2–V6. Upon transthoracic echocardiography the apical type of a Takotsubo syndrome was suspected. Since coronary angiography was normal and electrocardiography and echocardiographic abnormalities resolved under candesartan, bisoprolol, acetyl-salicylic acid, and atorvastatin within a few days after onset, Takotsubo syndrome was diagnosed.

Since Takotsubo syndrome may be associated with transient global amnesia a causal relation may exist. A possible trigger for both conditions could be severe emotional stress from the loss of a close relative. A possible common pathomechanism could be overstimulation of adrenergic receptors in the myocardium, the cerebrum, or the coronary or cerebral arteries. Whether pre-existing myocardial compromise promotes the development of Takotsubo syndrome requires further investigations.

• Broken heart syndrome
• Catecholamines
• Heart failure
• Memory
• Stress cardiomyopathy
• Stunned myocardium

Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period.

A 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment.

This report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.

• Myocardial contrast echocardiography
• Takotsubo cardiomyopathy

A comprehensive analysis of published cases of Takotsubo cardiomyopathy, occurred in liver transplant recipients in the perioperative period, has been attempted in this review. Predisposing factors, precipitating events, potential physiological mechanisms, acute and post-event management have been discussed.

• Takotsubo cardiomyopathy
• liver transplant
• precipitating events
• predisposing factors

• Impella device
• Takotsubo cardiomyopathy
• severe sepsis