Tako-Tsubo cardiomyopathy after cardiopulmonary resuscitation during emergency Cesarean section in a 28 year old patient in the 31st week of pregnancy

Objective: Tako-Tsubo Cardiomyopathy is an extremely rare, reversible cardiomyopathy. The signs and symptoms can mimic myocardial infarction, including chest pressure, dyspnea, ECG abnormalities, and elevated cardiac enzymes. Although Tako-Tsubo primarily affects postmenopausal women ages 60 – 70, rare cases in younger patients have been described. A 28 year old patient in the 31^st week of pregnancy presented with fetal bradycardia on admission. An emergency Cesarean section was performed. We describe a case of Tako-Tsubo Cardiomyopathy following intraoperative cardiopulmonary resuscitation (CPR).

Materials and methods: not applicable.

Results/Course: A 28 year old G2 P1 presented on the Labor and Delivery ward with premature labor, a fully dilated cervix, breech presentation, and fetal bradycardia. An emergency C-section was performed. Approximately 3 – 5 minutes following oxytocin administration, the patient experienced a sinus tachycardia followed by a pulseless ventricular tachycardia. CPR was performed immediately. Return of spontaneous circulation was obtained after 3 minutes of CPR. Over the next 24 hours the patient's condition declined. Serial cardiac enzymes increased (peak Troponin-T > 700), Brain natriuretic peptide (NTproBNP) increased (> 3000), echocardiography showed decreased left ventricular ejection fraction with wall motion abnormalities and ballooning leading to a diagnosis of Tako-Tsubo Cardiomyopathy. The patient was asymptomatic on discharge. Discharge echocardiography showed an almost complete reversal of abnormalities. 4 week postoperative Troponin T and BNP were 19 and 246 pg/ml respectively.

Summary: Although Tako-Tsubo occurs mostly in postmenopausal women, rare peripartum and postpartum cases have been described. The signs and symptoms should be recognized early to prevent serious and potentially fatal complications.