Takotsubo cardiomyopathy following ergometrine administration during caesarean section

We report three patients who developed Takotsubo cardiomyopathy (TTCM) or reverse TTCM following administration of ergometrine for postpartum bleeding. All three women were antenatally well with no personal or family history of any cardiovascular conditions. Shortly after birth, all three patients demonstrated cardiovascular compromise. Transthoracic echocardiogram (TTE) demonstrated markedly impaired left ventricular (LV) systolic function with either Takotsubo or reverse TTCM. All patients spent a period in the intensive care unit for inotropic support and commencement of heart failure therapy. Serial TTE demonstrated marked improvement with a normal LV ejection fraction within 13 days for all cases. By 6 months, all three women were off all heart failure medications. TTCM differs from peripartum cardiomyopathy, with LV ejection fraction typically recovering within 1 month of delivery. Judicious use of ergometrine in the management of an atonic uterus, even women with no cardiovascular history, is necessary.