Stress-Induced Cardiomyopathy Following Elective Lumbar Disc Nucleotomy: Multimodal Cardiac Evaluation With 2D-STE...

Minimally invasive lumbar spinal surgery can precipitate rare perioperative Takotsubo syndrome (stress-induced cardiomyopathy, SIC), a condition frequently misdiagnosed as acute myocardial infarction. Cardiac magnetic resonance (CMR) serves as a valuable diagnostic tool for the multimodal evaluation of Takotsubo syndrome, helping exclude alternative etiologies such as myocarditis. Diagnosis of Takotsubo syndrome relies on comprehensive integration of clinical manifestations, ventricular imaging, coronary angiography, electrocardiography, and cardiac biomarkers, rather than depending on CMR alone. We herein report the case of a 66-year-old postmenopausal woman without conventional cardiovascular risk factors who developed Takotsubo syndrome shortly after elective lumbar discectomy. Obstructive coronary artery lesions were ruled out by coronary angiography. Owing to the patient's claustrophobia, we implemented a combined imaging protocol of two-dimensional speckle-tracking echocardiography (2D-STE) and dynamic single‑photon emission computed tomography (D-SPECT), which verified reversible myocardial dysfunction. The patient received guideline-directed medical therapy consisting of sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and a sodium‑glucose cotransporter 2 (SGLT2) inhibitor. Cardiac biomarkers returned to normal levels on postoperative day 11, and myocardial strain parameters showed substantial improvement at the eight-week outpatient follow-up. This case underscores the need for clinical vigilance for Takotsubo syndrome after spinal surgery. In this individual patient with CMR contraindications, combined 2D‑STE and D‑SPECT provided complementary supportive diagnostic information. Further studies are required to validate the general utility of this multimodal imaging approach.