Severe form of tacotsubo syndrome after spinal anesthesia for vascular surgical intervention

Abstract

We present a clinical case of a patient who suffered from takotsubo syndrome after spinal anesthesia, due to bilateral vascular operation (embolism of the arteries of the lower limbs). Takotsubo syndrome is caused by an exaggerated catecholamine overload, which is often triggered by strong emotional stress or trauma, and may mimic acute coronary syndrome. In this specific case, in the postoperative period, the patient had anginal symptoms, unstable hemodynamics, ischemic ECG changes, and high levels of troponin. The echocardiographic finding showed akinesia of the apical and middle segments
of the left ventricle. The angiography excluded coronary artery occlusion. Even though in most cases Takotsubo syndrome is benign, in our case the patient developed a severe form of the disease, which lead to her demise. The only preventive measure is the preoperative premedication against emotional stress. In conclusion - this syndrome should not be underestimated – even though most patients fully recover, in the most serious forms the prognosis could be poor.