Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review

Takotsubo cardiomyopathy (TTCM) is a form of stress cardiomyopathy that may occur in the perioperative period and among the critically ill. Therefore, anesthesiologists should be aware of its diagnosis and treatment. The aim of this narrative review is describe the features of TTCM and its relevance to the practice of anesthesiology.

Takotsubo cardiomyopathy occurs in about 2-9/100,000 persons in the general population annually and may occur in up to one in 6,700 cases in the perioperative period. Takotsubo cardiomyopathy often presents like an acute coronary syndrome and is likely caused by excessive catecholamine stimulation. Although its early course may be complicated, more than 90% of patients survive the acute episode. A review of the literature revealed 131 cases encountered in many different types of surgical procedures, with 37% occurring during anesthesia or surgery and 58% occurring postoperatively. Compared with non-perioperative cases, this population involved more males, was younger, less likely to have an obvious precipitating factor, less likely to present with chest pain, and less likely to exclusively exhibit the apical ballooning pattern. In addition, perioperative TTCM had a lower ejection fraction and was prone to higher mortality. Detection is facilitated by early echocardiography. Anesthesiologists may encounter TTCM in other situations including patients undergoing other non-surgical procedures (e.g., electroconvulsive therapy), those with acute central nervous system conditions, those with pheochromocytoma, in other critical illnesses, and during allergic reactions.

Perioperative TTCM is more common than appreciated and should be considered in any hospitalized patient presenting with acute coronary syndrome and/or hemodynamic instability, acute respiratory distress, as well as cardiac arrhythmias and arrest.