A case of takotsubo cardiomyopathy after surgery for common bile duct stones
Masayuki Tori1, Shigeyuki Ueshima, Masaaki Nakahara
1Department of Surgery, Osaka Police Hospital, Osaka, Japan.
Insights
Takotsubo cardiomyopathy (TC), a reversible heart condition, can occur after surgery. This case highlights TC as a potential complication following hepato-biliary-pancreatic surgery.
Area of Science:
- Cardiology
- Gastroenterology
- Geriatric Medicine
Background:
- Takotsubo cardiomyopathy (TC) is a rare, reversible heart condition.
- It is frequently observed in elderly individuals post-general surgery.
Observation:
- An 85-year-old woman presented with obstructive jaundice, undergoing ERCP, ENBD, cholecystectomy, and choledocholithotomy.
- Postoperatively, she developed ECG abnormalities (ST-T elevation) without elevated cardiac biomarkers.
- Echocardiography revealed basal hyperkinesis and apical dyskinesis, characteristic of TC.
Findings:
- The patient recovered with conservative management, normalizing ECG within a month.
- The stress associated with hepato-biliary-pancreatic surgery is a potential trigger for TC.
Implications:
- TC should be considered a potential complication in patients undergoing hepato-biliary-pancreatic surgery.
- Early recognition and conservative management are key for favorable outcomes in TC.
Abstract:
Takotsubo cardiomyopathy (TC) is a rare reversible circulatory syndrome often detected in elderly patients after general surgery. We report the case of an 85-year-old woman who was admitted for obstructive jaundice and underwent ERCP and ENBD before operation. She finally underwent cholecystectomy and choledocholithotomy with the diagnosis of gallbladder and common bile duct stones. In the evening just after the operation, without symptoms of cardiac failure, her ECG suddenly exhibited abnormal ST-T elevation in leads II, III, and V2-V6, though neither CPK(MB) nor troponin T was elevated. Echocardiogram demonstrated basal hyperkinesis and apical dyskinesis, suggesting TC. Conservative treatment enabled recovery, ECG was normalized in a month, and the postoperative course was satisfactory. The stress on her during treatment might have been a cause of this unique cardiomyopathy, and it should be recalled that TC is a potential complication of hepato-biliary-pancreatic surgery.
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