Acute Takotsubo Cardiomyopathy during Elective Hernia Repair in a Patient with Previously Resected Pheochromocytoma

Ethan L. Sanford, Thomas Hickey, Jeffrey Lu

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

The authors'patient underwentsurgicalstimulus,possible CO2 embolus, andsufferedhemodynamiccollapsewithsub-sequent resuscitationincludingbolusdosingofepinephrine.These factorslikelycontributedtodevelopmentofTakotsubo cardiomyopathy. Theircaseemphasizespractitionercognizance of Takotsubocardiomyopathyasacauseofacute,decom- pensated leftventricularfailure,especiallyinpatientswitha history ofpheochromocytoma.Totheauthors' knowledge, there hasbeennoreportofTakotsuboinpatientspost-resection of apheochromocytomaorparaganglioma.Thecasesuggests patients whohavehadsustainedcatecholamineexposuremay be predisposedtoTakotsuboevenyearsafterpresumed curative procedures.Thistopicmeritsfurtherinvestigation.The patientdiddemonstrateelevationinplasmacatechol-amines andelevatedbloodpressures,possiblyindicating continued increasesinsympathetictone,againconceivably increasing theriskfordevelopmentofTakotsubo.Whilethere are insufficient datatosuggestchangestostandardpreoperative cardiac evaluationinthesepatients,adetailedpreoperaive history andphysicalexaminationfocusedonthecardiacsystem should bethestandard,withalowthresholdforfurther diagnostics. Earlyechocardiographyandcatheter-basedevalu-ation shouldbeusedtoassesspersistentcardiovascular instability ifTakotsuboissuspected.Anearlyinitiationof LV mechanicalassistdevicesalsoshouldbeconsidered. Finally, whileIVepinephrinewasgivenappropriatelyin response toPEAintheauthors' patient, IVvasopressinmay be ausefulalternativetoepinephrineduringresuscitationof patients withsuspectedTakotsubocardiomyopathy.

Original languageEnglish (US)
Pages (from-to)1596-1598
Number of pages3
JournalJournal of cardiothoracic and vascular anesthesia
Volume29
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Keywords

  • epinephrine
  • intraoperative
  • pheochromocytoma
  • stress-induced cardiomyopathy
  • Takotsubo

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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