Acute Takotsubo Cardiomyopathy During Elective Hernia Repair in a Patient With Previously Resected Pheochromocytoma

THERE HAS BEEN A DRAMATIC INCREASE in detection of Takotsubo cardiomyopathy (also known as stress-induced cardiomyopathy or broken heart syndrome) since its initial description. Takotsubo cardiomyopathy has been reported in the presence of various physiologic stressors such as noncardiac surgery, pneumothorax, alcohol withdrawal, hypoglycemia, and myasthenic crisis. Emotional and/or physiologic stress, chest pain, ST elevation on electrocardiogram (ECG), elevated troponins, left ventricular (LV) apical hypokinesis/ ballooning, and absence of any coronary arterial lesion have been used as clinical criteria for diagnosis. Female predominance (85%) has been noted along with increasing risk with age. Differentiation of Takotsubo from acute coronary syndromes has proven problematic without cardiac catheterization. ECG findings have been studied, and while reciprocal T wave changes in Takotsubo are less common than in acute coronary syndrome, they still occur in a significant portion of cases. The authors present case details and review literature on intraoperative Takotsubo, especially as it pertains to patients with a history of pheochromocytoma/paraganglioma.