Cardiogenic shock secondary to Tako-tsubo syndrome after debridement of malignant endobronchial obstruction.
Transient left ventricular (LV) dysfunction syndrome, or Tako-tsubo syndrome, occurs following intense emotional or physical stress and simulates the clinical presentation of an acute myocardial infarction. We report a case of a 77-year-old man with esophageal adenocarcinoma with local invasion of the central airways who underwent rigid bronchoscopy for tumor debridement followed by placement of a stent. Postoperatively, cardiogenic shock developed and echocardiography revealed akinesis of the LV apex with an ejection fraction (EF) of 15%. Emergent coronary angiography revealed no significant coronary artery disease. The patient required intraaortic balloon counterpulsation and pressors. Seventy-two hours later, repeat echocardiography showed an EF of 45% with improvement in apical function, and the patient was discharged home in stable condition shortly thereafter. A 5-month follow-up echocardiogram revealed an EF > 55%, and the patient enjoyed an excellent performance status.
Guerrero
Jorge
J
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Majid
Adnan
A
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ernst
Armin
A
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: aernst@bidmc.harvard.edu.
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects*; D003646:Debridement / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015607:Stents; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000601:surgery