We present the case of a 48-year-old female patient, with a history of uterine cervical cancer for which she received surgical and radiotherapy treatment. One year later, a second intervention was performed, for occlusive syndrome in the setting of post-irradiation enteritis. While in the ICU, in the 48 hours after surgery, the patient developed dyspnea with orthopnea and anterior thoracic pain. The clinical exam shows tachycardia, LV gallop, pulmonary crackles, systemic congestion and hypotension, despite vasopressor support. Blood tests showed positive troponin levels and a high NT-proBNP. The ECG revealed ST-segment elevation, while the echocardiography showed circumferential apical akinesia and severe LV systolic dysfunction with an ejection fraction of 25%. An emergency angiography was performed, which did not find any coronary lesions. For the next 10 days, the patient’s condition improved constantly, with significant improvement of systolic function. As such, the final diagnosis was Takotsubo cardiomyopathy, triggered by the surgical intervention.
Our case had an association of all of the possible trigger factors (neoplasia, anesthesia, major surgery), which perhaps explains the severity of the disease in a patient with no previous cardiovascular disease.