Authors: Hafid S et al.
Cureus, Volume 18, Issue 1, Article e101699, January 2026. DOI: 10.7759/cureus.101699.
Summary
This case report describes a rare and severe perioperative presentation of Takotsubo cardiomyopathy (TTS) in a previously healthy 32-year-old woman following minor otologic surgery. Approximately 15 minutes after an uncomplicated stapedotomy under general anesthesia, the patient developed sustained monomorphic ventricular tachycardia that progressed to cardiac arrest. Return of spontaneous circulation was achieved with defibrillation. Immediate bedside echocardiography revealed profound left ventricular systolic dysfunction (LVEF ≈20–25%) with apical ballooning, consistent with TTS.
Post-resuscitation electrocardiography showed lateral T-wave inversions and QTc prolongation, while cardiac biomarkers demonstrated only a modest troponin elevation disproportionate to the degree of ventricular dysfunction. Early management required vasoactive and inotropic support, which was rapidly de-escalated once TTS was suspected to avoid exacerbating catecholamine-mediated myocardial injury. Left ventricular function improved within 48 hours and normalized within one week. Cardiac MRI confirmed diffuse myocardial edema without late gadolinium enhancement, excluding ischemic or inflammatory cardiomyopathy and supporting the diagnosis of TTS.
This case emphasizes that perioperative TTS can occur even in young patients undergoing low-risk surgery and may present dramatically with malignant ventricular arrhythmias and cardiac arrest. The authors highlight the diagnostic value of rapid point-of-care echocardiography and cardiac MRI in distinguishing TTS from acute coronary syndromes, enabling appropriate management and avoidance of unnecessary invasive procedures.
What You Should Know
Perioperative Takotsubo cardiomyopathy is uncommon but can present abruptly with life-threatening ventricular arrhythmias and cardiac arrest.
Severe TTS can occur after minor surgery and in young patients without cardiovascular risk factors.
Bedside echocardiography is critical in cases of unexplained perioperative cardiovascular collapse to identify acute ventricular dysfunction.
Cardiac MRI is highly valuable for confirming TTS and excluding myocardial infarction or myocarditis.
Key Points
Presentation: Sudden ventricular tachycardia and cardiac arrest during emergence from anesthesia after minor surgery.
Diagnosis: Marked but reversible LV dysfunction with apical ballooning, modest troponin rise, QTc prolongation, and MRI evidence of myocardial edema without necrosis.
Management: Initial hemodynamic stabilization followed by rapid reduction of catecholaminergic support once TTS was suspected.
Outcome: Full recovery of ventricular function within one week, consistent with the reversible nature of TTS.
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