Takotsubo cardiomyopathy as an atypical presentation of maternal heart disease in twin pregnancy. A case report

ABSTRACT: We present the case of a woman of advanced age for pregnancy, multiparous, with assisted fertilization and dichorionic diamniotic twin pregnancy of 33.5 weeks with cardiovascular risk factors (sedentary lifestyle, smoking, high degree of work stress, chronic hypertension, hypertriglyceridemia) who developed gestational diabetes and peripartum hypertensive disease (severe preeclampsia). A cesarean section was performed due to an obstetric complication, during surgery, after birth, she presented hypertensive crisis and acute pulmonary edema that required coronary critical care. Biochemical markers and electrocardiographic, radiological, and angiographic studies were conclusive of Takotsubo syndrome. Her cardiovascular condition was complicated by a cerebral thrombosis resolved with an interventional catheterization. Recovery was satisfactory after a torpid evolution, cardiac function improved remarkably, blood pressure stabilized with drugs, and metabolic morbidities remained unaltered. Mild dysarthria was the only neurological sequelae. Obstetric aspects and the most important cardiovascular data of the case are discussed. Keywords: Takotsubo syndrome; Acute coronary syndrome; Acute myocardial infarction; Maternal heart disease; Hypertensive crisis; High risk pregnancy