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Takotsubo cardiomyopathy - An unexpected complication in spine surgery.

Hammer N, Kühne C, Meixensberger J, Hänsel B, Winkler D - Int J Surg Case Rep (2014)

Bottom Line: The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery.Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis.The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pump function.

View Article: PubMed Central - PubMed

Affiliation: Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany. Electronic address: niels.hammer@medizin.uni-leipzig.de.

No MeSH data available.


Related in: MedlinePlus

Levocardiography in the right anterior oblique position shows the picture of an octopus pot, which is characteristic for Takotsubo cardiomyopathy.
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fig0015: Levocardiography in the right anterior oblique position shows the picture of an octopus pot, which is characteristic for Takotsubo cardiomyopathy.

Mentions: After anesthesiological and clinical preparation including tibialis somatosensory and motor evoked potentials without pathologies, surgery was carried out. The patient was lying in a prone position with constant monitoring under general anesthesia by means of propofol and sulfentanil. Following fluoroscopy and skin incision, the Th9 lamina was explored and removed under intermittent ultrasound confirming the correct intraoperative positioning. The neurinoma was visualized and removed microsurgically. Shortly before completion, sudden circulation (84/60 mmHg) and blood gas analysis disturbances were observed (endexpiratory pCO2 24 mmHg, capillary pO2 pressure 84%). The intraoperative ECG showed acute ST elevations (Fig. 1), as typically associated with acute myocardial infarction. Due to pump-failure related hypotension, medication was adapted as follows: noradrenaline at 0.12 μg/kg/min and dobutamine at 2 μg/kg/min via feeding pump, adrenaline in fractions of 1.8 mg and cafedrin–theodrenaline in 80 mg boluses. Acetylsalicylic acid (500 mg) was administered for the suspected diagnosis. Sufentanil (0.2 μg/kg/h), propofol (6 mg/kg/h) and midazolam (5 mg boluses) were continuously administered via feeding pump until the surgery was finished. Cardiac enzymes, including CK and CK-MB, remained at normal levels at all times. In cardiac angiography, no critical coronary disease was observed, but the presence of a typical apical ballooning and midventricular hypokinesis (Fig. 2). The following levocardiography showed the typical octopus pot configuration of the heart (Fig. 3). After diagnosing the Takotsubo cardiomyopathy, therapy was adapted symptomatically upon the patient's overall clinical condition. Metoprolol (47.5 mg twice daily) and ramipril (5 mg once daily) were administered to prevent volume overload and to exclude further events. Anticoagulation therapy was stated with nadroparine for the first three days due to the risk of a left ventricular thrombus. The administration of acetylsalicylic acid was stopped because of the absence of a coexisting coronary atherosclerosis.


Takotsubo cardiomyopathy - An unexpected complication in spine surgery.

Hammer N, Kühne C, Meixensberger J, Hänsel B, Winkler D - Int J Surg Case Rep (2014)

Levocardiography in the right anterior oblique position shows the picture of an octopus pot, which is characteristic for Takotsubo cardiomyopathy.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4334960&req=5

fig0015: Levocardiography in the right anterior oblique position shows the picture of an octopus pot, which is characteristic for Takotsubo cardiomyopathy.
Mentions: After anesthesiological and clinical preparation including tibialis somatosensory and motor evoked potentials without pathologies, surgery was carried out. The patient was lying in a prone position with constant monitoring under general anesthesia by means of propofol and sulfentanil. Following fluoroscopy and skin incision, the Th9 lamina was explored and removed under intermittent ultrasound confirming the correct intraoperative positioning. The neurinoma was visualized and removed microsurgically. Shortly before completion, sudden circulation (84/60 mmHg) and blood gas analysis disturbances were observed (endexpiratory pCO2 24 mmHg, capillary pO2 pressure 84%). The intraoperative ECG showed acute ST elevations (Fig. 1), as typically associated with acute myocardial infarction. Due to pump-failure related hypotension, medication was adapted as follows: noradrenaline at 0.12 μg/kg/min and dobutamine at 2 μg/kg/min via feeding pump, adrenaline in fractions of 1.8 mg and cafedrin–theodrenaline in 80 mg boluses. Acetylsalicylic acid (500 mg) was administered for the suspected diagnosis. Sufentanil (0.2 μg/kg/h), propofol (6 mg/kg/h) and midazolam (5 mg boluses) were continuously administered via feeding pump until the surgery was finished. Cardiac enzymes, including CK and CK-MB, remained at normal levels at all times. In cardiac angiography, no critical coronary disease was observed, but the presence of a typical apical ballooning and midventricular hypokinesis (Fig. 2). The following levocardiography showed the typical octopus pot configuration of the heart (Fig. 3). After diagnosing the Takotsubo cardiomyopathy, therapy was adapted symptomatically upon the patient's overall clinical condition. Metoprolol (47.5 mg twice daily) and ramipril (5 mg once daily) were administered to prevent volume overload and to exclude further events. Anticoagulation therapy was stated with nadroparine for the first three days due to the risk of a left ventricular thrombus. The administration of acetylsalicylic acid was stopped because of the absence of a coexisting coronary atherosclerosis.

Bottom Line: The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery.Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis.The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pump function.

View Article: PubMed Central - PubMed

Affiliation: Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany. Electronic address: niels.hammer@medizin.uni-leipzig.de.

No MeSH data available.


Related in: MedlinePlus