A Case of Takotsubo Cardiomyopathy Presented with Cardiogenic Shock after Surgery for Gastric Cancer

Tetsuya Okino, Takashi Kurizaki, Chitoshi Ohara, Ryoujin Uchino and Ikuo Misumi*

Department of Surgery and Department of Cardiology*, Kumamoto Saishunso National Hospital

A 74-year-old woman with gastric cancer underwent total gastrectomy with hepatic lateral segmentectomy. On postoperative day 1, she reported chest compression with sudden-onset tachycardia and respiratory distress without chest pain. Chest X-ray showed cardiomegaly, and electrocardiography showed ST-segment elevation in precordial leads. Troponin T and BNP increased, although no elevation occurred in other cardiac enzymes. We diagnosed the case as Takotsubo cardiomyopathy based on typical findings of echocardiography in which the base of the left ventricle was hyperkinetic and the remainder of the left ventricle akinetic. On POD6, the woman suddenly developed severe hypoxia and cardiogenic shock, necessitating mechanical ventilation. Chest X-ray showed congestion and a pneumonia shadow suggestive of exacerbated heart failure due to pneumonia. A sputum culture obtained yielded MRSA. With amelioration in pneumonia, however, her condition improved and abnormal left ventricular movement disappeared during postoperative week 3. It is thus important to recognize this disease when it happens because it occurs unexpectedly with common surgical treatment such as surgery, anesthesia, endoscopic examination, and other procedures requiring.

Key words
Takotsubo cardiomyopathy, gastric cancer, cardiogenic shock

Reprint requests
Tetsuya Okino Department of Surgery, Kumamoto Saishunso National Hospital
2659 Suya, Koushi, 861-1196 JAPAN

Accepted
October 22, 2008

To read the PDF file you will need Abobe Reader installed on your computer.