Cardiogenic shock secondary to Tako-tsubo syndrome after debridement of malignant endobronchial obstruction

Chest. 2009 Jan;135(1):217-220. doi: 10.1378/chest.08-0790. Epub 2008 Aug 8.

Abstract

Transient left ventricular (LV) dysfunction syndrome, or Tako-tsubo syndrome, occurs following intense emotional or physical stress and simulates the clinical presentation of an acute myocardial infarction. We report a case of a 77-year-old man with esophageal adenocarcinoma with local invasion of the central airways who underwent rigid bronchoscopy for tumor debridement followed by placement of a stent. Postoperatively, cardiogenic shock developed and echocardiography revealed akinesis of the LV apex with an ejection fraction (EF) of 15%. Emergent coronary angiography revealed no significant coronary artery disease. The patient required intraaortic balloon counterpulsation and pressors. Seventy-two hours later, repeat echocardiography showed an EF of 45% with improvement in apical function, and the patient was discharged home in stable condition shortly thereafter. A 5-month follow-up echocardiogram revealed an EF > 55%, and the patient enjoyed an excellent performance status.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Aged
  • Bronchoscopy / adverse effects*
  • Debridement / adverse effects*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Humans
  • Male
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology*
  • Shock, Cardiogenic / therapy
  • Stents
  • Takotsubo Cardiomyopathy / complications*
  • Takotsubo Cardiomyopathy / surgery