title: Takotsubo cardiomyopathy in an 81-year-old woman after injection of bone cement during hemiarthroplasty: An orthogeriatric case report.
abstract: BACKGROUND
  Takotsubo cardiomyopathy is a syndrome characterized by transient cardiac ischemia-like symptoms, such as chest pain, increase of myocardial necrosis markers, electrocardiographic changes, and temporary left ventricular apical ballooning without significant coronary artery disease, often triggered by a particularly stressful situation. The association between Takotsubo and hip fracture surgery has been rarely reported in the literature.
  
  
  METHODS
  An 81-year-old woman was hospitalized with a diagnosis of right femoral neck fracture. During the surgical procedure, she displayed acute coronary symptoms a few minutes after the injection of bone cement, in the absence of coronary lesions. Due to the time relationship, bone cement implantation syndrome - not uncommon to observe - was considered in the differential diagnosis. However, the instrumental findings and the transient nature of the abnormalities guided us toward a diagnosis of Takotsubo. The treatment with Levosimendan, Amiodarone, and Metoprolol allowed gradual and satisfactory recovery of the cardiac function within a few days. The follow-up performed two and six months after surgery revealed complete cardiac recovery, and ability to walk at home comparable to the pre-fracture situation.
  
  
  CONCLUSIONS
  Takotsubo cardiomyopathy is more common in women during the postmenopausal phase, especially if undergoing stressful physical or emotional stimuli. In this case, the sequence of hip fracture, pain, hospitalization, and surgery could easily be intended as a strong stressful event with high physical/psychological burden.
  
  
  CONCLUSIONS
  Despite the good prognosis associated with early recognition, Takotsubo represents a life-threatening adverse event. Considering its possible pathogenesis, a "gentle care" approach and the optimization of pain control must be pursued in elderly subjects with hip fracture, aiming at reducing the stress of the hospitalization and related procedures.
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy. Electronic address: paolo.mazzola@unimib.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzola
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Picone
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Anzuini
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Corsi
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Annoni
keywords: Elderly; Hip fracture; Orthogeriatric; Takotsubo; Transient cardiomyopathy