A Case of “Takotsubo” Cardiomyopathy with Ventricular Tachycardia after Surgery for Rectal Perforation

Abstract

A 71-year-old woman taking 10 mg/day of predonisolone for rapidly progressive glomerulonephritis wasadmitted for severe abdominal pain. Temperature was 38.8°Cand she had a muscular rigidity with tenderness in the lower abdomen. Abdominal X-ray and CT showed intraperitoneal free air and a large amount of feces inthe rectouterine pouch. Under a diagnosis of rectal perforation, we partially resected the rectum and con-structed a terminal colostomy. The patient was returned to the intensive care unit and treated on an artificial respirator with continuous hemodiafiltration. The postoperative course was satisfactory until postoperative day (POD) 7. Eight days after surgery, she suddenly reported general fatigue and ventricular tachycardia oc-curred in electrocardiography. The ST segment was elevated in leads II, III, aV_F, and V₂-V₆. Ultrasound car-diography showed asynergy of apical akinesis and basal hyperkinesis with a significant pressure gradient of 60-130 mmHg. She was diagnosed with “takotsubo” cardiomyopathy. The left ventricular function improved to almost normal within the next 3 weeks. This possibility showed thus be kept as a potential complication af-ter gastrointestinal surgery.