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Table of Contents
Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 111-112
Echocardiographic findings of stress cardiomyopathy in a young parturient with acute abdomen

Second Department of Anesthesiology, National and Kapodistrian University of Athens, 1 Rimini Street, Haidari, 124 62 Athens, Greece, EU, Greece

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Date of Submission20-Mar-2021
Date of Decision16-May-2021
Date of Acceptance19-May-2021
Date of Web Publication03-Jan-2023

How to cite this article:
Spiliotaki E, Soulioti E, Kouki P, Saranteas T. Echocardiographic findings of stress cardiomyopathy in a young parturient with acute abdomen. Ann Card Anaesth 2023;26:111-2

How to cite this URL:
Spiliotaki E, Soulioti E, Kouki P, Saranteas T. Echocardiographic findings of stress cardiomyopathy in a young parturient with acute abdomen. Ann Card Anaesth [serial online] 2023 [cited 2023 Jan 30];26:111-2. Available from:

To the Editor,

We present a case of a young healthy parturient who was admitted to our hospital for scheduled caesarian delivery. The procedure was uneventful. A week later, the patient was transferred to the operating theater due to bowel perforation. During surgery, she became hemodynamically unstable (blood pressure: 70/40 mmHg, heart rate: 95 pulse/min) requiring treatment with vasopressors and fluids. Postoperatively, the patient was transferred to the intensive care unit (ICU). The electrocardiogram revealed ST segment in V2-V6 leads. Troponin and pro-brain natriuretic peptide levels were moderately elevated. A transthoracic echocardiography (TTE) examination was performed by an anesthetist who was competent at TTE (certified by the European Association of Cardiovascular Imaging). The two-dimensional (2D) imaging revealed reduced left ventricular (LV) function with ejection fraction (EF) of 40%. Akinesia of the apex (mainly at the apical interventricular septum) and hypercontractile basal myocardial segments were visualized [Video 1]. Speckle-tracking echocardiography revealed reduced global longitudinal peak systolic strain (GLPSS):15.9%, [Figure 1]. Strain values were low in the LV apex and in all the basal hyperkinetic segments (apart from the inferior wall). The coronary angiogram was negative for coronary disease. The diagnosis of stress cardiomyopathy (SC) was established.[1],[2],[3],[4] The patient was weaned off of vasopressors and discharged from the ICU 4 days later. She was referred to the cardiology department since her cardiac function had not completely recovered.
Figure 1: Speckle-tracking echocardiography with reduced global longitudinal peak systolic strain. Strain values are low in the apex of the left ventricle and in all the basal hyperkinetic segments except for the inferior myocardial wall

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In SC, the most characteristic TTE findings are apical ballooning and LV regional wall motion abnormalities in an area extending beyond the territory of one single coronary artery that is counteracted by normal or even hyperkinetic basal contractility.[1],[2] Electrocardiographic changes are frequently reported, and cardiac troponin is typically elevated.[1],[2] The GLPSS can also be employed to evaluate regional myocardial function.[3] Of note, in the acute phase of SC, the longitudinal peak systolic strain changes in apical and basal segments. There is a decrease in the longitudinal peak systolic strain values from the base to the apex of the heart, with the distribution across myocardial segments taking the image of the “evil eye.”[4] Although in normal individuals, systolic longitudinal strain exhibits a small base-to-apex gradient, such that successive shortening strains are higher at the apical and mid-segments with respect to the LV base,[5] in patients with SC, significant base-to-apex gradient indicates a more severe involvement of the cardiac apex.[3],[4] In our case, at the apex, the segmental peak longitudinal strain values were partially reduced (apical anterior and apical inferior segments: −22 and − 23, apical cap: −17, apical antero-septum: −12 and apical anterior segment: −12). However, lower strain values with more uniform distribution than the apex were found in the basal hyperkinetic segments (except for the inferior myocardial wall). A base-to apex gradient also developed which was completely opposite to that presented frequently in patients with SC.[3],[4],[5] It was very likely that the increased circumferential/radial function of the basal LV segments (2D imaging) compensated for the reduced longitudinal myocardial function (2D strain).

In conclusion, the perioperative use of TTE by properly trained anesthetists can contribute to the diagnosis of SC. Nevertheless, it should be kept in mind that echocardiographic findings can vary and may be misleading at times.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myo-cardial infarction. Am Heart J 2008;155:408-17.  Back to cited text no. 1
Awad HH, McNeal AR, Goyal H. Reverse Takotsubo cardiomyopathy: A comprehensive review. Ann Transl Med 2018;6:460.  Back to cited text no. 2
Heggemann F, Weiss C, Hamm K, Kaden J, Süselbeck T, Papavassiliu T, et al. Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy. Eur J Echocardiogr 2009;10:760-4.  Back to cited text no. 3
Sosa S, Banchs J. Early recognition of apical ballooning syndrome by global longitudinal strain using speckle tracking imaging--the evil eye pattern, a case series. Echocardiography 2015;32:1184-92.  Back to cited text no. 4
Sengupta PP, Khandheria BK, Korinek J, Wang J, Jahangir A, Seward JB, et al. Apex-to-base dispersion in regional timing of left ventricular shortening and lengthening. J Am Coll Cardiol 2006;47:163-72.  Back to cited text no. 5

Correspondence Address:
Eleni Spiliotaki
Idras 24, Haidari, 12462, Athens
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aca.aca_26_21

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  [Figure 1]