90th Annual Meeting Abstracts
Tako-Tsubo Syndrome in a Surgical Patient
*Kushi B Bhatt, MD, *Frederick N Eko, MD, *Jedidiah G Almond, MD, *Jeffrey A Leppo, MD, Eugene L Curletti, MD
Berkshire Medical Center, Pittsfield, MA
Tako-Tsubo Syndrome (TTS) occurs during periods of extreme mental or physical stress. Tako-Tsubo (or octopus trap in Japanese), refers to the appearance of the left ventricle. It is characterized by akinesia of the left ventricular apex resulting in inefficient ventricular contraction. Most common in postmenopausal women, it has been reported in Japan and Europe. We present a postoperative patient who developed TTS after exploratory laparotomy and small bowel resection for perforation.
We present the case of a 73 year old obese lady with congestive heart failure, coronary artery disease as well as anithrombin III deficiency. She presented to the emergency department complaining of acute onset abdominal pain. Physical exam revealed left lower quadrant tenderness and erythema, crepitus and a diagnosis of necrotizing fasciitis was made. Intraoperatively, a perforation of the small bowel by a bezoar (plastic fork prong) was found at the site of small bowel perforation. Resection and primary anastomosis of the perforation was performed.
On postoperative day 4 she developed shortness of breath and altered mental status. She was found to have nonspecific electrocardiogram changes as well as elevated troponins to 15 ng/ml. Echocardiogram showed akinesis of the anterior, apical and distal septal ventricular walls, with an ejection fraction of 35%. A diagnosis of Tako-Tsubo Syndrome was made by the cardiology consultant. She was managed with cardiopulmonary support in the intensive care unit for a week. She subsequently recovered and was transferred to the surgical floor. The rest of her postoperative course was uneventful.