Background & Aim
To review the features of pregnancy-related takotsubo syndrome (pTTS)
Method
Case report and literature review.
Results
A 27-year-old woman developed chest pain and dyspnoea four hours post-caesarean delivery with epidural anaesthesia after prolonged labour. ECG normal, troponin 1861ng/L (<34), BNP 651ng/L (<100), pulmonary oedema on CXR. CTPA negative for pulmonary embolism. No features suggestive amniotic fluid embolism. Echocardiography revealed multiple areas of left ventricular hypo/akinesia not corresponding to any coronary territory with LVEF 30-35%, consistent with pTTS. 7 days postpartum LVEF improved to 40-45%. LV size and function were normal six weeks postpartum. Plasma metanephrines were normal.
pTTS complicated 3 in 100000 pregnancy-related hospitalisations,1/10 the prevalence of peripartum cardiomyopathy (PPCM).1 103 cases have been described. 26 occurred pre-delivery, 22 post-vaginal delivery (71% within 24 hours) and 55 post-caesarean (96% within 24 hours). Acute pulmonary oedema, cardiogenic shock and cardiac arrest complicated 18%, 24% and 16% respectively. There were no maternal deaths. Features differentiating pTTS from PPCM include earlier onset postpartum, greater elevation of serum troponin, transient regional hypokinesia/akinesias and full recovery of LVEF within 6 weeks of presentation. The RETAKO registry reported no complications or recurrences after median follow-up of 1353 days in 6 individuals with pTTS. Additionally, four women with previous TTS had subsequent pregnancies without recurrence. Acute management and therapies to prevent recurrences are not known.
Conclusion
Differentiation of pTTS from PPCM is critical with respect to prognosis and management. Interrogation of international registries would be valuable regarding prediction of recurrence in subsequent pregnancies.