The Sudden Death of a Pregnant Woman With Takotsubo Cardiomyopathy Following a Legal Abortion: A Case Report
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 13 No. 3 (2023),
17 October 2023
,
Page 42616
https://doi.org/10.32598/ijmtfm.v13i3.42616
Abstract
Background: Takotsubo cardiomyopathy (TCM) is characterized by left ventricular dysfunction and apical ballooning due to physical or mental stress in the absence of coronary artery disease. This transient heart disorder is rare in pregnancy. It may affect women of reproductive age.
Case Presentation: The case was a 38-year-old woman in the first trimester of pregnancy with a history of TCM diagnosis one year ago, admitted to the hospital for a legal abortion. At the time of hospitalization, echo cardiography, echo cardiography, and clinical tests results were normal; however, due to stressful factors, such as the cancellation of the dilation & curettage (D&C) procedure, despite being transferred to the operating room (due to the absence of a gynecologist), receiving misoprostol for two consecutive days, the prolongation of surgery time, as well as the absence of a psychiatrist to reduce stress during the operation, suffered from recurrent TCM and eventually expired. In the autopsy, the cause of death was a massive pulmonary embolism.
Conclusion: In pregnant women, there is a possibility of TCM recurrence due to changes in hormonal levels and emotional and physical stress caused by pregnancy. Therefore, when performing a surgical procedure such as D&C, a team consisting of gynecologists, cardiologists, and psychiatrists should be present to avoid dangerous complications such as sudden death.
- Takotsubo cardiomyopathy
- Broken heart syndrome
- Pulmonary embolism
- Pregnancy
- 09/30/2023 (2)
- 09/23/2023 (1)
How to Cite
References
Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. American Heart Journal. 2008; 155(3):408-17. [DOI:10.1016/j.ahj.2007.11.008] [PMID]
Bajolle F, Basquin A, Lucron H, Bonnet D. Acute ischemic cardiomyopathy after extreme emotional stress in a child. Congenital Heart Disease. 2009; 4(5):387-90. [DOI:10.1111/j.1747-0803.2009.00277.x] [PMID]
Maruyama S, Nomura Y, Fukushige T, Eguchi T, Nishi J, Yo- shinaga M, et al. Suspected takotsubo cardiomyopathy caused by withdrawal of bupirenorphine in a child. Circulation Journal. 2006; 70(4):509-11. [DOI:10.1253/circj.70.509] [PMID]
Nayeri A, Rafla-Yuan E, Farber-Eger E, Blair M, Ziaeian B, Cadeiras M, et al. Pre-existing psychiatric illness is associated with increased risk of recurrent Takotsubo cardiomyopathy. Psychosomatics. 2017; 58(5):527-32. [DOI:10.1016/j.psym.2017.04.008] [PMID] [PMCID]
Suzuki T, Nemoto C, Ikegami Y, Yokokawa T, Tsukada Y, Abe Y, et al. Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section. Journal of Anesthesia. 2014; 28(1):121-4. [DOI:10.1007/s00540-013-1677-6] [PMID]
Yaqub Y, Jenkins LA, Nugent KM, Chokesuwattanaskul W. Postpartum depression and apical ballooning syndrome (takotsubo syndrome). Journal of Obstetrics and Gynaecology Canada. 2009; 31(8):736-9. [DOI:10.1016/S1701-2163(16)34279-7] [PMID]
Corrigan FE 3rd, Kimmel MC, Jayaram G. Four cases of takotsubo cardiomyopathy linked with exacerbations of psychiatric illness. Innovations in Clinical Neuroscience. 2011; 8(7):50-3. [PMID]
Virani SS, Khan AN, Mendoza CE, Ferreira AC, de Marchena E. Takotsubo cardiomyopathy, or broken-heart syndrome. Texas Heart Institute Journal,. 2007; 34(1):76-9. [PMID]
Templin C, GhadriJ R, Diekmann J, Napp LC, Bataiosu DR, Ja- guszewski M, et al. Clinical features and outcomes of takotsubo (Stress) Cardiomyopathy. The New England Journal of Medicine. 2015; 373(10):929-38. [DOI:10.1056/NEJMoa1406761] [PMID]
Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST- segment elevation: A novel cardiac syndrome mimicking acute myocardial infarction. American Heart Journal. 2002; 143(3):448-55. [DOI:10.1067/mhj.2002.120403] [PMID]
Parodi G, Del Pace S, Carrabba N, Salvadori C, Memisha G, Simonetti I, et al. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. The American Journal of Cardiology. 2007; 99(2):182-5.[DOI:10.1016/j.amjcard.2006.07.080] [PMID]
Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. European Heart Journal. 2006; 27(13):1523-9. [DOI:10.1093/eurheartj/ehl032] [PMID]
Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. Journal of the American College of Cardiology. 2006; 47(8 Suppl):C13-8. [DOI:10.1016/j.jacc.2005.10.065] [PMID]
Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, et al. Tako-Tsubo cardiomyopathy: Intraindividual structural anal- ysis in the acute phase and after functional recovery. European Heart Journal. 2007; 28(20):2456-64. [DOI:10.1093/eurheartj/ehl570] [PMID]
Nef HM, Möllmann H, Hilpert P, Troidl C, Voss S, Rolf A, et al. Activated cell survival cascade protects cardiomyocytes from cell death in Tako-Tsubo cardiomyopathy. European Journal of Heart Failure. 2009; 11(8):758-64. [DOI:10.1093/eurjhf/hfp076] [PMID]
Y-Hassan S. Myocarditis and takotsubo syndrome: Are they mutually exclusive? International Journal of Cardiology. 2014; 177(1):149-51. [DOI:10.1016/j.ijcard.2014.09.056] [PMID]
Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syn- drome: A position statement from the taskforce on takotsubo syndrome of the heart failure Association of the European So- ciety of Cardiology. European Journal of Heart Failure. 2016; 18(1):8-27. [DOI:10.1002/ejhf.424] [PMID]
Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, et al. International expert consensus document on takotsubo syndrome (Part i): Clinical characteristics, diagnostic criteria, and pathophysiology. European Heart Journal. 2018; 39(22):2032-46. [DOI:10.1093/eurheartj/ehy077] [PMID] [PMCID]
Schubert S, Kucia A, Hofmeyer A. The gap in meeting the educational and support needs of women with takotsubo syndrome compared to women with an acute coronary syndrome. Contemporary Issues in Education Research. 2018; 11(4):133-44. [DOI:10.19030/cier.v11i4.10207]
Murashko LE. Gormonal’nye izmeneniia pri iskusstvennom aborte 7--8 ned beremennosti [Hormonal changes in artificial abortion in the 7th-8th weeks of pregnancy (Russian)]. Sovetskaia Meditsina. 1978; (6):75-80. [PMID]
Koridze MN. [Effect of induced abortion on the functional state of the steroid-producing endocrine glands and the sympathetic adrenal system (Russian)]. Akusherstvo i Ginekologiia. 1988; (2):62-4. Russian. [PMID]
Blanchard K, Clark S, Winikoff B, Gaines G, Kabani G, Shannon C. Misoprostol for women’s health: A review. Obstetrics and Gynecology. 2002; 99(2):316-32. [PMID]
No Authors. Misoprostol: Serious cardiovascular events, even after a single dose. Prescrire International. 2015; 24(162):183-4. [PMID]
Singh K, Carson K, Shah R, Sawhney G, Singh B, Parsaik A, et al. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. The American Journal of Cardiology. 2014; 113(8):1420-8. [PMID]
Armstrong EM, Bellone JM, Hornsby LB, Treadway S, Phillippe HM. Pregnancy-Related Venous Thromboembolism. Journal of Pharmacy Practice. 2014, 27(3);243-52.[DOI:10.1177/0897190014530425] [PMID]
Simcox LE, Ormesher L, Tower C, Greer IA. Pulmonary thrombo-embolism in pregnancy: Diagnosis and management. Breathe (Sheff). 2015; 11(4):282-9. [DOI:10.1183/20734735.008815] [PMID] [PMCID]
Arrigo M, Huber LC. Pulmonary embolism and heart failure: A reappraisal. Cardiac Failure Review. 2021; 7:e03. [DOI:10.15420/cfr.2020.26] [PMID] [PMCID]
Minatoguchi M, Itakura A, Takagi E, Nishibayashi M, Kikuchi M, Ishihara O. Takotsubo cardiomyopathy after cesarean: A case report and published work review of pregnancy-related cases. The Journal of Obstetrics and Gynaecology research. 2014; 40(6):1534-9. [DOI:10.1111/jog.12437] [PMID]
Ono R, Falcão LM. Takotsubo cardiomyopathy systematic review: Pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy. International Journal of Cardiology. 2016; 209:196-205. [DOI:10.1016/j.ijcard.2016.02.012] [PMID]
Pellicia F, Siangra G, Elliott P, Parodi G, Basso C, Camici PG. Takotsubo is not a cardiomyopathy. International Journal of Cardiology. 2018; 254:250-3. [DOI:10.1016/j.ijcard.2017.12.009] [PMID]
- Abstract Viewed: 342 times
- pdf Downloaded: 248 times