Anesthetic management in a patient previously diagnosed with takotsubo cardiomyopathy

Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the...

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Bibliographic Details
Published in:	Revista española de anestesiología y reanimación Vol. 55; no. 3; p. 179
Main Authors:	Batllori Gastón, M, Gil Gorricho, M J, Zaballos Barcala, N, Gracia Aznárez, M Y, Urchaga Litago, A, Murillo Jason, E
Format:	Journal Article
Language:	Spanish
Published:	Spain 01-03-2008
Subjects:	Acute Coronary Syndrome - diagnosis Aged Anesthesia, Intravenous - methods Anesthesia, Spinal - methods Anesthetics, Intravenous - administration & dosage Anti-Anxiety Agents - administration & dosage Anti-Anxiety Agents - therapeutic use Anxiety - drug therapy Anxiety - etiology Arthroplasty, Replacement, Hip - psychology Comorbidity Diagnosis, Differential Drug Therapy, Combination Female Femoral Neck Fractures - psychology Femoral Neck Fractures - surgery Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - therapeutic use Intraoperative Complications - prevention & control Midazolam - administration & dosage Midazolam - therapeutic use Preanesthetic Medication Propofol - administration & dosage Secondary Prevention Stress, Psychological - drug therapy Stress, Psychological - etiology Takotsubo Cardiomyopathy - diagnosis Takotsubo Cardiomyopathy - prevention & control
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Summary:	Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the reported cases an emotional or physical stress event has been identified as a trigger, and perioperative stress has been suggested as the trigger in some of these cases. Outcome is favorable with the right treatment, though recurrences are possible. We report the anesthetic management of a 79-year-old woman with a previously diagnosed episode of Takotsubo cardiomyopathy, who was admitted to our hospital for total hip replacement. Care was taken to provide proper preoperative sedation before provision of hyperbaric spinal anesthesia, followed by sedation with intravenous propofol. Surgery and the early postoperative period were uneventful. We believe that minimizing perioperative anxiety should be a priority in these patients due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy.
ISSN:	0034-9356
DOI:	10.1016/S0034-9356(08)70537-1