A 47‐year‐old woman was referred to us from the gynecology department at our institution after she complained of chest pain. She was admitted to the hospital for abnormal uterine bleeding and pelvic pain and was scheduled for a vaginal hysterectomy. Preoperative electrocardiogram (EKG) showed normal sinus rhythm. Preoperative echocardiogram revealed normal left ventricular systolic function. Laparoscopic vaginal hysterectomy and left ovarian cystectomy were performed successfully. On the second postoperative day, the patient complained of chest pain radiating to the left arm. Physical examination was unremarkable. Laboratory analysis revealed white blood cell count of 13,400/μL and a hemoglobin level of 10.3 g/dL. Cardiac enzymes were elevated, with troponin T of 4.91 ng/mL, myoglobin of 145 ng/mL, and creatine kinase fraction‐MB fraction of 18.1 ng/mL. EKG revealed ST‐segment elevation and T‐wave inversions in leads V1 and V2. Echocardio‐gram revealed mild to moderately decreased left ventricular systolic function (ejection fraction of 40%) with apical and anterolateral akinesis. Coronary angiography revealed clean coronaries. A diagnosis of takotsubo cardiomyopathy was made.
Takotsubo syndrome is transient left ventricular apical dysfunction typically seen in postmenopausal women after physical or emotional stress. Takotsubo cardiomyopathy can be diagnosed by 4 criteria suggested by Bybee et al.: (1) transient akinesis or dyskinesis of apical and midventricular segments of the left ventricle with regional wall motion abnormalities extending beyond the distribution of single epicardial vessel; (2) no obstructive coronary artery disease or angiographic evidence of plaque rupture; (3) new ST‐segment elevation and/or T‐wave inversion; and (4) absence of subarachnoid hemorrhage, pheochromocytoma, head trauma, or hypertrophic cardiomyopathy. We report a unique presentation of takot‐subo cardiomyopathy in the perioperative setting of laparoscopic vaginal hysterectomy and unilateral ovarian resection. The perioperative period can cause stress, and cases of takotsubo syndrome in the perioperative period have been reported in the literature. This is explained by catecholamine surge in stress, causing myocardial stunning because of diffuse microvascular dysfunction and/or multivessel spasm of epicardial vessels. In experimental rats, Ueyama et al. demonstrated that an increase in estradiol levels can provide a protective effect against the pathologic cardiac changes caused by stress. This explains why this syndrome is more common in post‐menopausal women. This could be because of alteration in endothelial activity when estrogen levels are low.
Because takotsubo cardiomyopathy is common in postmenopausal women, it would be interesting to study the incidence of this syndrome after surgical menopause, that is, after bilateral oophorectomy.
A. Vallakati ‐ none; N. Nerella ‐ none; V. Shetty ‐ none
To cite this abstract:Vallakati A, Nerella N, Shetty V. Takotsubo Cardiomyopathy After Laparoscopic Hysterectomy. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 418. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/takotsubo-cardiomyopathy-after-laparoscopic-hysterectomy/. Accessed September 17, 2019.