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Case Reports in Anesthesiology
Volume 2017, Article ID 8641641, 4 pages
https://doi.org/10.1155/2017/8641641
Case Report

Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure

1Department of Anesthesiology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
2Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece

Correspondence should be addressed to Emmanuel Lilitsis; rg.oohay@sistililm

Received 15 March 2017; Accepted 8 May 2017; Published 13 June 2017

Academic Editor: Anjan Trikha

Copyright © 2017 Emmanuel Lilitsis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM) immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT) surgery for stress urine incontinence). TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.