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Tako-tsubo syndrome caused by caesarean clinically different to peripartum cardiomyopathy

Takotsubo cardiomyopathy is similar to Peripartum Cardiomyopathy but it is thought that the stress of a medical procedure such as spinal anesthesia, general anesthesia, and surgery, or an emotional and physical stress of the delivery could have induced the disease and caused left ventrical enlargement, as opposed to myocardial inflammation associated with infection or autoimmunity.

In a small study of 15 patients, 13 subjects were found to present the onset of Tako-tsubo syndrome, with caesarean. Although 13 patients experienced acute cardiac complications (pulmonary edema, cardiogenic shock, cardiac arrest), in all left ventricular systolic function normalized within 13.43 ± 10.96 days. http://journals.lww.com/jcardiovascularmedicine/Abstract/2013/08000/Is_Tako_tsubo_syndrome_in_the_postpartum_period_a.4.aspx

Recovery from Tako-tsubo syndrome is more rapid than peripartum cardiomyopathy.

Women who recover quickly postpartum from cardiomyopathy, should consider Takotsubo Syndrome as an alternative diagnosis.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053557/ is a case of a 28-year old woman who underwent Caesarean delivery. She presented with acute heart failure and pulmonary edema immediately after the delivery. Her echocardiography showed severe LV dysfunction and apical ballooning. This case is clinically and pathophysiologically similar to peripartum cardiomyopathy.

DISCUSSION

There would certainly be many women diagnosed with peripartum cardiomyopathy who in fact had Tako-tsubo syndrome and the risk of future pregnancy would be different in these cases than for peripartum cardiomyopathy. Avoiding Caesarean delivery, and other stresses would perhaps prevent a subsequent episode of Tako-tsubo syndrome.

Published Tuesday, 21 January 2014 by Jeanee Andrewartha

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