Severe reverse Takotsubo cardiomyopathy and cardiogenic shock during Caesarean section surgery under epidural...

Takotsubo cardiomyopathy is a type of acute heart failure typically following an emotional or physical stressor. Reverse Takotsubo is a rare pattern representing only 2% of the disease. There are many reported medical triggers, including surgical procedures, intubation, and induction of general anaesthesia.

A 27-year-old medically free pregnant woman who developed a sudden cardiogenic shock during caesarean section surgery under epidural anaesthesia. The initial Electrocardiography showed a high lateral ST elevation myocardial infarction. Although the result of Left cardiac catheterization was normal coronaries, the transthoracic echocardiography (TTE) indicated the presence of severe reduction in the left ventricular function with TTE findings of reverse Takotsubo syndrome. The patient was managed with inotropic support, diuresis, and intra-aortic balloon pump insertion. She showed good clinical improvement, and left ventricular function was recovered within a few days.

This case shows that reverse Takotsubo cardiomyopathy may occur in young women, particularly in the postpartum period, undergoing anaesthesia and stress of caesarean section surgery. We recommend awareness of this possible diagnosis and further management of this unexpected variant of acute heart failure. A multidisciplinary approach is recommended to optimize outcomes for the mother and child.