In a case report submitted by Misumi et al. (2010), a 79-year-old man reported with chest pain three days in a row, findings after some testing revealed he had elevated troponins and elevated ST segments on EKG. A 2D echocardiogram showed left ventricular apical akinesis with basal hyperkinesia. He had a coronary angiogram completed, and it showed no stenotic arteries, however they also injected ergonovine which appeared to cause a right coronary artery spasm. The patient was treated with calcium channel blockers and nitrates. A follow up two weeks later showed normal wall motion as well as a sigmoid septum, and normal systolic function. He was ultimately diagnosed with takotsubo cardiomyopathy caused by coronary spasm and intraventricular
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TEE is becoming a crucial instrument in earlier diagnosis and management of takotsubo syndrome. In a case study completed by Mantilla (2016), A 22-year-old female was just prepared for surgery on her mandible when her heart rate became bradycardic and then abruptly advanced into supraventricular tachycardia. She had hypotension, persistent ST changes, and bronchospasms. There was bloody substance coming out of the nasotracheal tube which suggested pulmonary edema. A chest X-ray displayed severe pulmonary edema on both sides. An emergency TEE was performed on the patient, and it showed the classic apical ballooning present with takotsubo cardiomyopathy. Her right ventricle was dysfunctional and dilated mildly. The TEE presented with moderate tricuspid regurgitation, and a low cardiac output. Cardiac catheterization was also performed and no coronary disease was found. The patient was treated with milrinone, and after two days in the ICU the patient was mostly recovered with an ejection fraction of 60%, and was discharged 4 days later (Mantilla, 2016, p. 735). In this case, the patient was not nearing menopause, and before surgery seemed to be completely stable, emotionally. This case of takotsubo was induced by anesthetic stress. As stated, takotsubo cardiomyopathy may be caused by physical stress as well as emotional stress. Surgery, in this specific case, was a physical stressor for the patient’s body, and thus emergency procedures took place. When emergent results are needed during intraoperative periods, TEE is more helpful than transthoracic echo. For the Iowa Heart Center patient case that is being reviewed in this report, a transesophageal echo was not necessary, but had she been in surgery during her takotsubo incident or had body habitus
TEE is becoming a crucial instrument in earlier diagnosis and management of takotsubo syndrome. In a case study completed by Mantilla (2016), A 22-year-old female was just prepared for surgery on her mandible when her heart rate became bradycardic and then abruptly advanced into supraventricular tachycardia. She had hypotension, persistent ST changes, and bronchospasms. There was bloody substance coming out of the nasotracheal tube which suggested pulmonary edema. A chest X-ray displayed severe pulmonary edema on both sides. An emergency TEE was performed on the patient, and it showed the classic apical ballooning present with takotsubo cardiomyopathy. Her right ventricle was dysfunctional and dilated mildly. The TEE presented with moderate tricuspid regurgitation, and a low cardiac output. Cardiac catheterization was also performed and no coronary disease was found. The patient was treated with milrinone, and after two days in the ICU the patient was mostly recovered with an ejection fraction of 60%, and was discharged 4 days later (Mantilla, 2016, p. 735). In this case, the patient was not nearing menopause, and before surgery seemed to be completely stable, emotionally. This case of takotsubo was induced by anesthetic stress. As stated, takotsubo cardiomyopathy may be caused by physical stress as well as emotional stress. Surgery, in this specific case, was a physical stressor for the patient’s body, and thus emergency procedures took place. When emergent results are needed during intraoperative periods, TEE is more helpful than transthoracic echo. For the Iowa Heart Center patient case that is being reviewed in this report, a transesophageal echo was not necessary, but had she been in surgery during her takotsubo incident or had body habitus