Title : Takotsubo cardyopathy and cesarean delivery: A review of the evidence
Background: Tako-tsubo Cardiomyopathy (TTC) is a clinical condition, with presentation mimicking acute myocardial infarction [Bossone et al, Heart Fail Clin 2013]. Its estimated prevalence is approximately 1.7-2.2% of patients with suspected acute coronary syndrome [Bossone et al, Heart Fail Clin 2013]. Diagnosis is defined by Mayo Clinic criteria [Prasad et al, Am Heart J 2008]. Many physical or emotional stressors can trigger TTC [Summers et al, Heart Fail Clin 2013]. We aimed to check for the relationship between cesarean delivery and TTC.
Methods: We explored PubMed database, by using the searching keywords ‘takotsubo cardiomyopathy’ and/or ‘stress-induced cardiomyopathy’, in combination with ‘cesarean’ and/or ‘delivery’ and ‘partum’. Deadline for search was December 31, 2017.
Results: We found 15 cases (Table). The mean age of the group as a whole was 31.3±5.9 years (range 20, 19–39). Elective interventions were 7 (46.7%) and emergency interventions were 8 (53.3%). The mean age for elective and emergent group was 34.1±4.6 and 29.3±6.3, respectively (p=NS). Outcome was favorable in 15/15 cases (100%).
Discussion: TTC may occur either in peripartum and postpartum period, although they may be considered differentiate entities. Moreover, it has been reported the onset of TTC even before a cesarean section [Suzuki, J Anesth 2014]. Eclampsia, spinal anesthesia, cesarean delivery and sympathomimetic medications can increase the risk of occurrence. Even if uncommon, and due to the difficulty of diagnosing, pheochromocytoma in pregnancy is still missed, with high maternal and fetal mortality rate [van Zwet, AA Case Rep 2016]. TTC symptoms are often undistinguishable from acute coronary syndrome or pulmonary thromboembolism, and echocardiography may be a useful diagnostic tool [Minatoguchi, J Obset Gybaecol Res 2014]. Nursing and midwifery staff taking care of pregnant patients should be aware of the potential link between cesarean delivery and TTC. High clinical awareness and multimodality imaging of diagnosis of this unexpected variant of acute heart failure can allow prompt correction of the precipitating cause, and favorable outcome.