title: Takotsubo cardiomyopathy in two preoperative patients with pain.
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 microg/L and 0.14 microg/L (normal range <0.03 microg/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.
authors.affiliation: Cardiology Research Department, West Wing, Royal Victoria Hospital, Grosvenor Road, Belfast BT126BA, UK. michaeljdaly@hotmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daly
authors.forename: Lana J
authors.initials: LJ
authors.lastname: Dixon
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D002395:Catecholamines / Q000097:blood*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D010146:Pain / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D020107:Troponin T / Q000097:blood; D015854:Up-Regulation
chemical_list: D000700:Analgesics; D015415:Biomarkers; D002395:Catecholamines; D020107:Troponin T