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

Ethan L. Sanford; Thomas Hickey; Jeffrey Lu

doi:10.1053/j.jvca.2014.12.001

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 journal › Article › peer-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 language	English (US)
Pages (from-to)	1596-1598
Number of pages	3
Journal	Journal of cardiothoracic and vascular anesthesia
Volume	29
Issue number	6
DOIs	https://doi.org/10.1053/j.jvca.2014.12.001
State	Published - Dec 1 2015
Externally published	Yes

Keywords

Takotsubo
epinephrine
intraoperative
pheochromocytoma
stress-induced cardiomyopathy

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Anesthesiology and Pain Medicine

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10.1053/j.jvca.2014.12.001

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title = "Acute Takotsubo Cardiomyopathy during Elective Hernia Repair in a Patient with Previously Resected Pheochromocytoma",

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.",

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AU - Hickey, Thomas

AU - Lu, Jeffrey

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KW - stress-induced cardiomyopathy

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

Abstract

Keywords

ASJC Scopus subject areas

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