Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan

Anis Ghariani; Leila Dhiab; Fehmi Ferhi; Mohamed AB Abdessalem; Abdallah Mahdhaoui; Khaled B Jazia; Gouider Jeridi

doi:10.5005/jp-journals-10071-24118

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Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan

Anis Ghariani, Leila Dhiab, Fehmi Ferhi, Mohamed AB Abdessalem, Abdallah Mahdhaoui, Khaled B Jazia, Gouider Jeridi

Keywords : Echocardiography, Ectopic pregnancy, Heart failure, Levosimendan

Citation Information : Ghariani A, Dhiab L, Ferhi F, Abdessalem MA, Mahdhaoui A, Jazia KB, Jeridi G. Inverted Takotsubo Following a Ruptured Ectopic Pregnancy, Treated with Levosimendan. Indian J Crit Care Med 2022; 26 (2):228-230.

DOI: 10.5005/jp-journals-10071-24118

License: CC BY-NC 4.0

Published Online: 09-02-2022

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Abstract

Background: Takotsubo syndrome is a transient stunned myocardium that typically involves the apical and mid-ventricular segments. A variant, called Inverted Takotsubo, concerns the basal and mid-ventricular segments. Case summary: We present a ruptured ectopic pregnancy that was responsible for a catecholamine surge, which led to this stress-induced cardiomyopathy. Transthoracic echocardiography showed mid-basal segments akinesia and hypercontractility of the apical segments. Biology has shown mild elevated troponin and NT-pro-BNP levels which led to performing a coronary angiography that showed no angiographic stenosis. A left ventricle angiography evoked the diagnosis of inverted Takotsubo. The patient has received Levosimendan to allow progressive weaning of catecholamine inotropes. The clinical evolution was favorable. Echocardiography performed after 3 weeks, showed ad-integrum restitution of the left ventricular function. Discussion: Takotsubo syndrome should be evoked whenever a context of physical or psychological stress is present. We underline the usefulness of Levosimendan as a nonadrenergic inotrope in this particular context.

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Jasudavisius A, Arellano R, Martin J, McConnell B, Bainbridge D. Revue méthodique de l’échocardiographie transthoracique et transœsophagienne en chirurgie non cardiaque: implications pour la formation en échoguidage au chevet en salle d'opération. Can J Anesth 2016;63(4):480–487. DOI: 10.1007/s12630-015-0524-7.
Takashi U, Ken K, Takuzo H, Katsuhiro Y, Yoshihiro T, Ichiro N. Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: a possible animal model of “tako-tsubo” cardiomyopathy. Circ J 2002;66(7):712–713. DOI: 10.1253/circj.66.712.
Ramaraj R, Movahed MR. Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congest Hear Fail 2010;16(6):284–286. DOI: 10.1111/j.1751-7133.2010.00188.x.
Hurst RT, Askew JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, et al. Transient midventricular ballooning syndrome. a new variant. J Am Coll Cardiol 2006;48(3):579–583. DOI: 10.1016/j.jacc.2006.06.015.
Bainbridge D, Cheng D. La cardiomyopathie provoquée par le stress dans un contexte périopératoire. Can J Anesth 2009;56(6):397–401. DOI: 10.1007/s12630-009-9085-y.
Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18(1):8–27. DOI: 10.1002/ejhf.424.

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