"Broken heart" after cesarean delivery. Case report and review of literature

Abstract

Objective To present a rare case of a multiparous woman
undergoing elective cesarean section with apparent symptoms
of acute coronary syndrome and who was later
diagnosed with Takotsubo cardiomyopathy (TCM; ‘‘broken
heart syndrome’’). To review similar case reports
already reported in literature.
Methods Literature search on the occurrence of TCM in
pregnancy using MEDLINE and Cochrane databases.
Results TCM might occur in women with no known preexisting
cardiomyopathy and uncomplicated pregnancies
undergoing cesarean section, especially in combination
with the administration of catecholamines/vasoconstrictive
substances and possibly also oxytocin and prostaglandins.
Conclusions Since TCM is related to emotional and
physical stress, the surroundings during cesarean section
should be kept quiet and smooth. Adrenergic stimulants
(adrenaline, phenylephrine, ergonovine, ephedrine) and
anticholinergics (atropine) should be used with caution and
adequate volume substitution prior to the onset of spinal
analgesia for the prevention of hypotension should be
provided. If signs of an acute coronary syndrome during
cesarean section do occur, echocardiography is obligatory
for diagnosis of TCM.