title: Stunned myocardium after an anesthetic procedure in a pediatric patient - case report.
abstract: Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction <30%). The electrocardiogram showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities. Cardiac biomarkers were elevated (troponin 2.42 ng/ml, proBNP 8248 pg/ml). She was placed on diuretics, angiotensin-converting enzyme inhibitors, digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging. Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS.
authors.affiliation: Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. Electronic address: oliveira.joana@gmail.com.
authors.forename: Joana
authors.initials: J
authors.lastname: Faleiro Oliveira
authors.affiliation: Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Rebelo Pacheco
authors.affiliation: Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Moniz
authors.affiliation: Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Nunes
authors.affiliation: Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Clara
authors.initials: C
authors.lastname: Abadesso
authors.affiliation: Unidade de Cardiologia Pediátrica, Departamento de Pediatria do Hospital de Santa Maria, CHLN, Lisboa , Portugal.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rebelo
authors.affiliation: Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Loureiro
authors.affiliation: Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Almeida
mesh_terms: D000293:Adolescent; D000777:Anesthetics / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017682:Myocardial Stunning / Q000175:diagnosis / Q000209:etiology*; D015742:Propofol / Q000009:adverse effects*; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis
chemical_list: D000777:Anesthetics; D015742:Propofol
keywords: Idade pediátrica; Miocárdio atordoado; Pediatric population; Stunned myocardium; Síndrome Takotsubo; Takotsubo syndrome