JELLAD A, BEN AMEUR W, BOUSSABEH I, ANNABI MS, HERBEGUE B, BEN YOUSSEF S

Department of cardiology, Interior Security Forces Hospital, La marsa (TUNISIA)                                                 

Adresse pour  correspondance : Jellad Alaeddine ( from Tunisia) Email : Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser.

Background: Takotsubo syndrome is a reversible cardiomyopathy characterized by transient systolic ventricular dysfunction with a clinical presentation indistinguishable from acute coronary syndrome.

Case report: A 52 –year-old female with no particular history, was admitted in our hospital for surgery of an adenocarcinoma of the right colon .Preoperative evaluation and laboratory investigations were unremarkable.

Five minutes after general anaesthesia, the patient developped tachycardia and blood pressure decreased to 70/50 mmhg with elevation of ST segment in lead II as displayed on the patient monitor. The electrocardiogram (ECG) showed appearance of antero-septal ischemia. Transthoracic echocardiography (TTE) revealed altered left ventricular ejection fraction (LVEF =40%) with akinesia and ballooning of the entire apex.

On the second postoperative day, a coronary angiography showed healthy coronary arteries and a four-day follow-up TTE found an improvement of LVEF to 70 %.

Discussion and conclusion: Transcient left ventricular apical ballooning syndrome is diagnosed in 0.2% -2.6% of patients admitted to Intensive Care Units with diagnosis of acute myocardial ischemia. Generally, TTE reveals apical ballooning, with caracteristics akinesis of the mid and apical left ventricule. Increased release of cathecolamine is the triggering factor of takotsubo syndrom in most of the cases. Otherwise, favourable evolution is the rule for this phenomenon as it happened in our case