title: Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section.
abstract: Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, Fukushima, 960-1295, Japan, josho518@fmu.ac.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nemoto
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ikegami
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yokokawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tsukada
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Jiro
authors.initials: J
authors.lastname: Shimada
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Choichiro
authors.initials: C
authors.lastname: Tase
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D002585:Cesarean Section; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology