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case-report

Takotsubo Cardiomyopathy in Two Preoperative Patients with Pain

From the Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, UK.

Address correspondence and reprint requests to Dr. Michael J. Daly, Cardiology Research Department, West Wing, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK. Address e-mail to michaeljdaly{at}hotmail.com.

Abstract

Reversible stress-induced cardiomyopathy, i.e., Takotsubo cardiomyopathy, rarely presents in preoperative patients. We provide the case reports of two patients who presented with Takotsubo cardiomyopathy, which we surmise was due to excess endogenous catecholamine production in response to acute pain. Electrocardiogram revealed T-wave inversion, with peak Troponin-T elevation in each case, i.e., 0.66 µg/L and 0.14 µg/L (normal range <0.03 µg/L). Despite these findings consistent with acute myocardial infarction, neither patient had obstructive coronary disease at angiography. Left ventriculography showed apical ballooning, a typical feature of the Takotsubo syndrome. Ventricular dysfunction had resolved completely at repeat echocardiography 2 wk later, after adequate analgesia and surgery.