Perioperative Takotsubo Cardiomyopathy Revealed by Ventricular Arrhythmia After a Minor Surgery in a Young Woman

TL;DR

A young woman developed a rare stress-induced heart condition during minor surgery, leading to a cardiac arrest and later diagnosed as Takotsubo cardiomyopathy.

Contribution

This case highlights a rare perioperative presentation of Takotsubo cardiomyopathy with ventricular arrhythmia and cardiac arrest in a young patient.

Findings

Takotsubo cardiomyopathy was diagnosed via echocardiography and MRI after a patient experienced cardiac arrest during minor surgery.

The patient's heart function partially recovered within 48 hours and fully normalized within a week.

Multimodal imaging, especially cardiac MRI, was crucial in distinguishing TTS from ischemic injury.

Abstract

Takotsubo syndrome (TTS) is an acute, reversible form of stress-induced cardiomyopathy typically triggered by intense emotional or physical stress. Perioperative presentations are uncommon but increasingly recognized, and may present abruptly with severe hemodynamic instability or malignant arrhythmias. These forms can mimic anesthetic complications or acute coronary syndromes, delaying diagnosis. We report the case of a healthy 32-year-old woman who developed sustained monomorphic ventricular tachycardia followed by cardiac arrest 15 minutes after an uncomplicated stapedotomy under general anesthesia. Return of spontaneous circulation was achieved after two synchronized shocks. Post-resuscitation, vasoactive support was initiated after bedside echocardiography revealed a markedly reduced left ventricular ejection fraction (≈25%) with apical ballooning, consistent with Takotsubo cardiomyopathy. The post-arrest ECG revealed lateral T-wave inversions with QTc prolongation to 480 ms. Biomarkers showed a modest rise in high-sensitivity troponin. Left ventricular function partially improved within 48 hours and fully normalized at one week. Cardiac MRI confirmed diffuse myocardial edema without late gadolinium enhancement, consistent with Takotsubo cardiomyopathy. This case illustrates a rare but severe perioperative presentation of TTS, manifesting as ventricular tachyarrhythmia and cardiac arrest in a young patient undergoing minor otologic surgery. It highlights the importance of considering TTS in cases of unexplained intraoperative or immediate postoperative cardiovascular collapse, and underscores the diagnostic value of multimodality imaging, particularly cardiac MRI, in distinguishing TTS from ischemic myocardial injury.

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