title: Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy?
abstract: OBJECTIVE
  To conduct a systematic review of case reports about Tako-tsubo syndrome (TTS) after delivery in order to assess whether TTS in the postpartum period is a peculiar entity or only a variant form of peripartum cardiomyopathy.
  
  
  METHODS
  We performed a systematic literature search on the occurrence of TTS after Cesarean section or spontaneous delivery using the scientific literature databases Medline, EMBASE and the Cochrane library. We selected 14 case reports in English. Primary/elective cesarean section or spontaneous delivery; absence of preexisting cardiovascular disease or fetal malformations; identification of diagnostic criteria for TTS; onset of TTS symptoms after delivery were the inclusion criteria.
  
  
  RESULTS
  Fifteen cases were selected. Cesarean section 24 h before the onset of TTS was reported in 13. All patients presented dyspnea or chest pain. The majority had mild troponin elevation, non-ST-segment elevation. Apical ballooning was observed in 60% of cases, midventricular ballooning in 33%, basal ballooning in 7%. Although 13 patients experienced acute cardiac complications (pulmonary edema, cardiogenic shock, cardiac arrest), in all left ventricular systolic function normalized within 13.43 ± 10.96 days.
  
  
  CONCLUSIONS
  Women in the postpartum period, notably after Cesarean delivery, may represent another new vulnerable group at increased risk for TTS. TTS in the postpartum period should be considered a clinical entity different from peripartum cardiomyopathy with specific clinical, therapeutic and prognostic implications.
authors.affiliation: Cuore Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. rodolfocitro@gmail.it
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Roberta
authors.initials: R
authors.lastname: Giudice
authors.forename: Marco
authors.initials: M
authors.lastname: Mirra
authors.forename: Raffaele
authors.initials: R
authors.lastname: Petta
authors.forename: Cesare
authors.initials: C
authors.lastname: Baldi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis*; D002585:Cesarean Section / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000209:etiology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000209:etiology