Mid ventricular takotsubo syndrome in the immediate postoperative period in a patient with an ectopic pregnancy

Síndrome de Takotsubo medio ventricular en postoperatorio inmediato de gestante con embarazo ectópico

Introduction: Takotsubo cardiomyopathy (TCM) is characterized by acute and transient cardiac dysfunction, triggered by psychological or physical stressors. Although it is rare, TCM can present in 1-3% of patients consulting with acute coronary syndrome (ACS) manifestations. It has been described in pregnancy, especially in preeclampsia and in the postoperative period after cesarean delivery. We present an undescribed association in a young patient with an ectopic pregnancy in the immediate postoperative period. Case: 23-year-old woman, with no underlying comorbidities, who underwent surgery for an ectopic pregnancy. In the immediate postoperative period, she presented with sudden hemodynamic deterioration and cardiogenic shock. Severe left ventricular dysfunction with an ejection fraction of 17% and severe hypokinesis was documented after 48 hours of receiving norepinephrine and milrinone supportive therapy. Ventilatory and hemodynamic parameters improved after adding levosimendan and dobutamine. A control echocardiogram showed recovery of LVEF to 40% with a ventricular mid segment pattern. Takotsubo cardiomyopathy was considered. Cardiac MRI on day 9 after onset was normal showing full ventricular function recovery. Conclusion: Takotsubo cardiomyopathy may occur in young women of reproductive age exposed to surgical stress and may be induced by gestational conditions such as an ectopic pregnancy.

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