Takotsubo syndrome during induction of general anaesthesia

International audienceA 77-year-old female was admitted in our hospital for uterine prolapse surgery. She developed ventricular tachycardia during induction of general anaesthesia and after initial symptomatic measures, she was transferred to the coronary care unit. Heart failure persisted and electro-cardiographic changes mimicking acute myocardial infarction appeared. Coronary angiography was normal and left ventriculography revealed akinesis of the apical region of the left ventricle and apical ballooning during systole, with relative sparing of the base of the heart. Complete recovery of left ventricular function occurred 8 days after the initial onset of symptoms. A diagnosis of Takotsubo syndrome was made on the basis of consistent clinical and laboratory findings, typical echocardio-graphy and angiography findings, and reversible course. This case emphasises the importance of being aware of uncommon causes of cardiac dysfunction in stressful situations, especially during induction of general anaesthesia. Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, was first described in Japan as acute systolic heart failure caused by transient left ventricle apical akinesis [1]. This syndrome is usually triggered by stressful situations, and mainly affects elderly female patients [2]. The peri-operative period is well-known to induce stress in patients, and this diagnosis should be considered when a patient presents with left ventricular dysfunction or electrocardiographic changes mimicking acute myocardial infarction in stressful situations [3, 4], especially during the induction of general anaesthesia. We report the case of a 77-year-old female with Takotsubo syndrome that revealed itself during the induction of general anaesthesia. Case report A 77-year-old female was admitted to our hospital for vaginal repair of uterine prolapse. She had a history of facial neuralgia treated by clonazepam, venous insuffi-ciency, previous laparotomy under general anaesthesia and bilateral cataract surgery under peribulbar anaesthesia. There were no anaesthetic complications during these procedures. Pre-operative evaluation including electro-cardiography was unremarkable, arterial pressure was 150 ⁄ 80 mmHg, and cardiopulmonary auscultation was normal. The patient decided against spinal anaesthesia, and it was therefore decided to administer a target-controlled infusion (TCI) of propofol, combined with regional anaesthesia (bilateral paracervical and pudendal nerve blocks). Before transfer to the operating room, the patient received 50 mg hydroxyzine. In addition to standard monitoring, anaesthesia depth monitoring was performed during surgery to measure bispectral index (BIS). Her arterial pressure was 195 ⁄ 92 mmHg, and heart rate was 70 beats.min)1. Oxygen saturation was 95% with the patient breathing air. Pre-oxygenation was administered until the expired oxygen reached a fraction of 0.9