title: Post-partum hemorrhage complicated by reverse-Takotsubo cardiogenic shock; a novel therapeutic approach.
abstract: Takotsubo Cardiomyopathy (TTC) is a type of transient, yet severe left ventricular systolic dysfunction, rarely complicating extreme emotional stress ("primary" TTC) or critical medical/surgical illness ("secondary" TTC forms). Although usually reversible, TTC may result in cardiogenic shock with dismal prognosis. "Secondary" TTC forms are particularly in danger for this complication, bearing significantly worse short and long-term prognosis. Herein, we report a rare case of a life-threatening "secondary" TTC in a patient with post-cesarean section severe hemorrhage, and we point out that early co-administration of esmolol and levosimendan might be an effective and safe therapeutic approach in "reversing" TTC-induced cardiogenic shock, especially when invasive therapeutic strategies are practically unfeasible.
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece. Electronic address: y_papanikolaou@hotmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Papanikolaou
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece. Electronic address: appollon7@hotmail.com.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Makris
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece. Electronic address: vasotsolaki@yahoo.com.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Tsolaki
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece. Electronic address: kospath@yahoo.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spathoulas
authors.affiliation: Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece. Electronic address: ezakynth@yahoo.com.
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000503:physiopathology*; D049590:Postpartum Period; D011247:Pregnancy; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000209:etiology; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D011412:Propanolamines; C036604:esmolol
keywords: Cardiogenic shock; Esmolol; Levosimendan; Management; Pathophysiology-based; Reverse Takotsubo cardiomyopathy