title: [ST-segment elevation during general anesthesia for non-cardiac surgery: a case of takotsubo].
abstract: OBJECTIVE
  Takotsubo cardiomyopathy, also known as broken heart syndrome is a stress-induced cardiomyopathy, which can be interpreted as an acute coronary syndrome as it progresses with suggestive electrocardiographic changes. The purpose of this article is to show the importance of proper monitoring during surgery, as well as the presence of an interdisciplinary team to diagnose the syndrome.
  
  
  METHODS
  Male patient, 66 years old, with diagnosis of gastric carcinoma, scheduled for diagnostic laparoscopy and possible gastrectomy. In the intraoperative period during laparoscopy, the patient always remained hemodynamically stable, but after conversion to open surgery he presented with ST segment elevation in DII. ECG during surgery was performed and confirmed ST-segment elevation in the inferior wall. The cardiology team was contacted and indicated the emergency catheterization. As the surgery had not yet begun irreversible steps, we opted for the laparotomy closure, and the patient was immediately taken to the hemodynamic room where catheterization was performed showing no coronary injury. The patient was taken to the hospital room where an echocardiogram was performed and showed slight to moderate systolic dysfunction, with akinesia of the mid-apical segments, suggestive of apical ballooning of the left ventricle. Faced with such echocardiographic finding and in the absence of coronary injury, the patient was diagnosed with intraoperative Takotsubo syndrome.
  
  
  CONCLUSIONS
  Because the patient was properly monitored, the early detection of ST-segment elevation was possible. The presence of an interdisciplinary team favored the syndrome early diagnosis, so the patient was again submitted to safely intervention, with the necessary security measures taken for an uneventful new surgical intervention.
authors.affiliation: Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal. Electronic address: lboahora@yahoo.com.
authors.forename: Leticia Bôa-Hora
authors.initials: LB
authors.lastname: Rodrigues
authors.affiliation: Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Batista
authors.affiliation: Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Monteiro
authors.affiliation: Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal.
authors.forename: João Silva
authors.initials: JS
authors.lastname: Duarte
keywords: Acute coronary syndrome; Acute myocardial infarction; Anestesia geral; Angina; Cardiogenic shock; Choque cardiogênico; General anesthesia; Infarto agudo do miocárdio; Síndrome coronária aguda; Takotsubo