2013 Volume 136 Pages 115-122
A 72-year-old woman with diabetes mellitus and many dental caries was admitted with a deep neck phlegmon. On the third day of being treated with antibiotics, she complained of chest compression. Electrocardiography showed ST-segment elevation in the precordial leads. The cardiologist diagnosed the patient as Takotsubo cardiomyopathy based on both the typical findings of echocardiography in which the base of the left ventricle was hyperkinetic and the remainder of the left ventricle akinetic, and coronary angiography which did not demonstrate significant stenosis. The patient was treated in the Intensive Care Unit (ICU). One day later, computed tomography (CT) showed that the phlegmon had progressed to form a widespread abscess including the parapharyngeal space, a condition that is potentially life-threating. Takotsubo cardiomyopathy requires avoiding stress because it could cause a cardiogenic shock. However, the widespread deep neck abscess needed prompt surgical drainage. After a full discussion with the cardiologist and anesthesiologists, surgical drainage was performed under general anesthesia. Although congestive heart failure and pulmonary edema occurred during the perioperative period, intensive care including the use of diuretic and atrial natriuretic peptide (ANP) improved the patient’s condition. Abnormal left ventricular movement disappeared on the 18th day. The patient was discharged from the hospital on the 35th day.
Takotsubo cardiomyopathy has gained attention since recent studies pointed to a close relationship between stress and the condition. We should therefore be familiar with the characteristics of this disease because there is a chance we will encounter it in daily practice.
