title: Acute idiopathic heart failure following laparoscopic myotomy for achalasia of the esophagus.
abstract: BACKGROUND
  Stress-induced cardiomyopathy, also known as takotsubo cardiomyopathy, is not fully understood. It is thought to occur in patients who have signs and symptoms consistent with acute myocardial infarction but display no obstructive coronary lesions during heart catheterization. Characteristics include transient left ventricular dysfunction, wall motion abnormalities on echocardiogram, new electrocardiographic ST-segment changes, and the occurrence of a precipitating stressor.
  
  
  METHODS
  We present a patient who underwent Heller myotomy and suffered acute heart failure in the immediate postoperative period. Left heart catheterization revealed clean coronary arteries, and the patient fully recovered days later. While difficult to fully exclude drug-related causes, we believe this case to be consistent with takotsubo cardiomyopathy.
  
  
  CONCLUSIONS
  This unusual postoperative complication following uneventful laparoscopic surgery should be kept in mind when unsuspected cardiovascular compromise is seen in the early perioperative recovery period. In addition to the rare occurrence of acute coronary ischemia syndromes and possible perioperative pulmonary embolic events, cardiovascular decompensation related to acute stress syndromes or idiopathic pharmacologic responses must be considered. Even patients who seem most healthy can have complications that warrant immediate attention and treatment.
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Kelly G
authors.initials: KG
authors.lastname: Ural
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Grayson W
authors.initials: GW
authors.lastname: Menard
authors.affiliation: Universidad CES, Medellín, Colombia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
keywords: Cardiomyopathy–stress; Heller myotomy; esophageal achalasia; laparoscopy; takotsubo cardiomyopathy
references.citation: J Am Osteopath Assoc. 2012 Nov;112(11):743-7
references.pmid: 23139345
references.citation: Korean Circ J. 2010 Jun;40(6):277-82
references.pmid: 20589200
references.citation: Am Heart J. 2008 Mar;155(3):408-17
references.pmid: 18294473
references.citation: N Am J Med Sci. 2013 Feb;5(2):77-81
references.pmid: 23641366
references.citation: J Med Case Rep. 2011;5:382
references.pmid: 21846377
references.citation: Congest Heart Fail. 2010 Mar-Apr;16(2):80-1
references.pmid: 20412475
references.citation: Anesth Analg. 1988 Oct;67(10):949-55
references.pmid: 3262323
references.citation: Am J Gastroenterol. 2012 Dec;107(12):1817-25
references.pmid: 23032978
references.citation: Ann Thorac Surg. 2008 May;85(5):1729-34
references.pmid: 18442574
references.citation: Int Surg. 1993 Jan-Mar;78(1):76-8
references.pmid: 8473091