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Reverse Takotsubo syndrome, a case report of a rare cause for postpartum heart failure

Leo Kilian, Philip Haaf, Otmar Pfister, Annina S. Vischer, Olav Lapaire, Thilo Burkard
  • Leo Kilian
    Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
  • Philip Haaf
    Department of Cardiology, University Hospital Basel, Basel, Switzerland
  • Otmar Pfister
    Department of Cardiology, University Hospital Basel, Basel, Switzerland
  • Annina S. Vischer
    Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
  • Olav Lapaire
    Department of Gynecology and Pregnancy Medicine, University Hospital Basel, Basel, Switzerland
  • Thilo Burkard
    Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence; Department of Cardiology, University Hospital Basel, Basel, Switzerland | thilo.burkard@usb.ch

Abstract

Predominant causes for newly diagnosed postpartum heart failure are preeclampsia and peripartum cardiomyopathy. Being an anatomical variant of Takotsubo syndrome (TTS) reverse TTS in this period is rare. We present a 36 year old patient, who had delivered triplets by cesarean section. Because of postpartum bleeding she was administered sulprostone. Later she was transferred to the Intensive Care Unit with sudden development of dyspnea, tachypnea and tachycardia. Clinical symptoms, laboratory findings and chest radiograph showed signs of acute heart failure. Transthoracic echocardiography (TTE) revealed reverse TTS with moderately reduced left ventricular ejection fraction (LVEF 39%). The patient stabilized with loop diuretic, angiotensine-converting enzyme inhibitors and beta-blockade. Breast-feeding was discouraged and bromocriptine administered. Left ventricular function normalized (LVEF 60%) within four weeks. TTS should be considered in patients with early postpartum development of heart failure. Rapid cardiac recompensation after the start of adequate therapy and complete resolution of clinical symptoms and TTE findings are typical for postpartum TTS.

Keywords

Takotsubo; peripartum cardiomyopathy; sulprostone; case report; bromocriptin; postpartum heart failure.

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Submitted: 2018-07-03 23:06:18
Published: 2018-10-02 15:58:11
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Copyright (c) 2018 Leo Kilian, Philip Haaf, Otmar Pfister, Annina S. Vischer, Olav Lapaire, Thilo Burkard

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