Takotsubo syndrome during surgery for pheochromocytoma: an unexpected complication

ABSTRACT Takotsubo syndrome is a rare cause of systolic dysfunction and can be found as a clinical manifestation of pheochromocytoma. We present a case of rapid onset of systolic dysfunction with cardiogenic shock, which developed after the surgical excision of an adrenal gland tumor in a 60-year-old male. Coronary angiography excluded coronary artery disease. The echocardiography and ventriculography images suggested Takotsubo cardiomyopathy pattern. Following 2 weeks of inotropic and vasopressor therapy, the left ventricular function gradually improved, until complete resolution.

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Faculty Opinions recommendation of Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1120774.597955 ◽

2009 ◽

Author(s):

Brian Olshansky

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Risk Factor ◽

Left Ventricular Systolic Dysfunction ◽

Controlled Trial ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Artery Disease ◽

Randomised Controlled

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Faculty Opinions recommendation of Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1122755.579832 ◽

2008 ◽

Author(s):

Wolfgang Schoels

Keyword(s):

Coronary Artery Disease ◽

Left Ventricular Systolic Dysfunction ◽

Controlled Trial ◽

Stable Coronary Artery Disease ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Double Blind ◽

Double Blind Placebo ◽

Artery Disease

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Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Left Ventricular Systolic Dysfunction: Insights from the VA CART Program

American Heart Journal ◽

10.1016/j.ahj.2021.02.002 ◽

2021 ◽

Author(s):

Todd J. Brophy ◽

Theodore J. Warsavage ◽

Annika L. Hebbe ◽

Mary E. Plomondon ◽

Stephen W. Waldo ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Left Ventricular Systolic Dysfunction ◽

Stable Coronary Artery Disease ◽

Systolic Dysfunction ◽

Coronary Intervention ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Percutaneous Coronary ◽

Artery Disease

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Prognostic value of adiponectin in coronary artery disease: Role of diabetes and left ventricular systolic dysfunction

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2016.04.003 ◽

2016 ◽

Vol 118 ◽

pp. 58-66 ◽

Cited By ~ 4

Author(s):

Alessandra Pratesi ◽

Claudia Di Serio ◽

Francesco Orso ◽

Alice Foschini ◽

Nadia Bartoli ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Artery Disease

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Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

BMJ Case Reports ◽

10.1136/bcr-2021-242367 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242367

Author(s):

Hari Vivekanantham ◽

Martin Scoglio ◽

Philipp Suter ◽

Stephane Cook ◽

Yann Roux ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Takotsubo Syndrome ◽

Left Main ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Left Anterior Descending Artery ◽

Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

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Incremental value of subclinical left ventricular systolic dysfunction for the identification of patients with obstructive coronary artery disease

American Heart Journal ◽

10.1016/j.ahj.2009.10.030 ◽

2010 ◽

Vol 159 (1) ◽

pp. 148-157 ◽

Cited By ~ 50

Author(s):

Gaetano Nucifora ◽

Joanne D. Schuijf ◽

Victoria Delgado ◽

Matteo Bertini ◽

Arthur J.H.A. Scholte ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Incremental Value ◽

Artery Disease

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Unusual Sequence of Events in a Case of Takotsubo Syndrome

Case Reports in Cardiology ◽

10.1155/2018/5498052 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

C. Henriquez ◽

R. Landau ◽

N. Sabharwal ◽

D. Rodriguez ◽

V. Virparia ◽

...

Keyword(s):

Complete Resolution ◽

Systolic Function ◽

Systolic Dysfunction ◽

Takotsubo Syndrome ◽

Artery Cannulation ◽

Sequence Of Events ◽

Temporary Pacemaker ◽

Left And Right ◽

Artery Disease ◽

Lv Systolic Function

A 73-year-old female with multiple comorbidities including coronary artery disease was admitted for an elective PCI of a lesion detected in the RCA. On the day of the planned PCI, shortly after right femoral artery cannulation, the patient developed a sudden complete heart block requiring the administration atropine and insertion of a temporary pacemaker. Concomitantly, the patient developed acute pulmonary edema, hypotension, and hypoxia requiring intubation for mechanical ventilation. Vasopressors were administered. A coronary angiogram showed patent left and right coronary arteries, unchanged when compared to the previous angiogram. An echocardiogram performed in the cardiac catheterization lab revealed global hypokinesis of the left and right ventricles, with severe LV systolic dysfunction (EF<20%). Following an insertion of an intra-aortic balloon pump, the patient was transferred to the CICU. A repeat echocardiogram in the CICU two hours later revealed a classical echocardiographic presentation of Takotsubo syndrome, apical hypokinesis. By the next morning the patient’s hemodynamic status significantly improved, the balloon pump was removed, and vasopressors were discontinued. Another echocardiogram was performed 24 hours after the event occurred and revealed a marked improvement in LV systolic function (EF 60%), with complete resolution of apical and septal wall motion abnormalities. Three days after the event, the patient was successfully discharged and asymptomatic at two-month follow-up. This case illustrates an atypical presentation of Takotsubo syndrome that was witnessed from onset to its complete resolution during the patient’s hospital stay.

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