title: An unusual reason for severe bradycardia leading to cardiac arrest during general anaesthesia: a case report.
abstract: BACKGROUND
  Takotsubo cardiomyopathy also known as transient balooning syndrome is an increasingly reported phenomenon characterized by acute reversible apical or midventricular dysfunction. This stress- induced cardiomyopathy mimics myocardial infarction, but without significant coronary artery disease, and rarely presents in perioperative period.
  
  
  RESULTS
  We report a case of postmenopausal woman scheduled to undergo elective cholecystectomy, with no history of coronary artery disease. She presented perioperatively with Takotsubo cardiomyopathy by unique manifestation-asystoly. This uncommon cause of cardiac arrest during anaesthesia was possibly induced by preoperative emotional stress. There was full recovery thanks to intensive management. In Takotsubo cardiomyopathy related cardiogenic shock we used the calcium sensitiser levosimendan successfully.
  
  
  CONCLUSIONS
  Takotsubo cardiomyopathy has an excellent long-term prognosis and nearly all patients have full recovery of left ventricular function. We emphasize the importance of heavy premedication by stress compromised patients and the need of sufficiently deep anaesthesia and analgesia during surgeries.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and Faculty Hospital Brno, Czech Republic.
authors.forename: Klara
authors.initials: K
authors.lastname: Struzkova
authors.forename: Petr
authors.initials: P
authors.lastname: Stourac
authors.forename: Jan
authors.initials: J
authors.lastname: Kanovsky
authors.forename: Ivo
authors.initials: I
authors.lastname: Krikava
authors.forename: Michaela
authors.initials: M
authors.lastname: Toukalkova
authors.forename: Pavel
authors.initials: P
authors.lastname: Sevcik
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D001919:Bradycardia / Q000150:complications*; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D013315:Stress, Psychological; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis*