[Repeated anesthesia for a patient with Tako-Tsubo cardiomyopathy]

An 85-year-old woman recieved emergency repair of left obturator hernia under general anesthesia. The surgery was completed uneventfully. Shortly after the admission to the recovery unit, blood pressure dropped to 80mmHg and ECG showed negative T wave. Hypotension was successfully treated with colloid infusion and dopamine administration, but negative T wave was unchanged by nitrate infusion. The serum CK-MB examination indicated no cardiomyogenic problems. On postoperative day 13, she received emergency colostomy under general anesthesia. Large negative T wave still persisted. Immediately after induction of anesthesia, she showed hypotension, which recovered by fluid infusion and intravenous ephedrine. The UCG after surgery showed hypokinesis of the apex of left ventricle. She was diagnosed as Tako-tsubo myocardiopathy. One month after the second surgery, she received closure of colostomy under general anesthesia combined with continuous epidural anesthesia, when negative T wave was seen on the ECG. Negative T wave returned to normal 10 weeks after the first surgery. When unknown tachycardia and negative T waves are seen, Tako-tsubo cardiomyopathy should be considered.