[논문]유방확대술 중 발생한 Takotsubo 심근병 1례

이경묵; 김연환; 김정태; 황원중; 신진호

Abstract ▼ AI-Helper

Purpose: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothe...

Purpose: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. Methods: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. Results: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. Conclusion: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

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가설 설정

During the breast augmentation, much tumescent solution was injected to reduce bleeding. It is hypothesized that the injection of epinephrine and the enflurane anesthesia without premedication induced uncontrolled VPCs, which worsened the cardiomyopathy that occurred after the cardiogenic shock. Fortunately, the patient recovered dramatically without complications.

제안 방법

2). The patient was admitted to the cardiac Intensive Care Unit of the hospital, and coronary arteriographies were performed, which showed normal results. Takotsubo cardiomyopathy was diagnosed based on the normal angiographic findings and the characteristic findings from the echocardiogram.

대상 데이터

A 44-year-old woman was admitted to the Emergency Department of the authors’ hospital after a cardiac arrest resuscitated by cardiopulmonary resuscitation during her breast augmentation surgery in a local clinic.

성능/효과

In this article, the importance of careful history taking, careful pre-operative consultation on psychological suffering especially due to breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was seen.
Second, injection of much tumescent solution and enflurane anesthesia without premedication caused VPCs, which doubled the strength of the onset of Takotsubo cardiomyopathy. The effect of premedication on the occurrences of dysrhythmias was also described.

참고문헌 (8)

Dote K, Sato H, Tateishi H, Uchida T, Ishihara M: Myocardial stunning due to simultaneous multivessel coronary spasm: a review of 5 cases. J Cardiol 21: 203, 1991
Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I: Transient left ventricular apical baloooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 38: 11, 2001

상세보기
Cangella F, Medolla A, De Fazio G, Iuliano C, Curcio N, Salemme L, Mottola G, Agrusta M: Stress-induced cardiomyopathy presenting as acute coronary syndrome: takotsubo in mercogliano, southern Italy. Cardiovasc Ultrasound 5: 36, 2007
Brenner ZR, Powers J: Takotsubo cardiomyopathy. Heart Lungs 37: 1, 2008
Hief C, Borggrefe M, Chen X, Martinez-Rubio A, Hachenberg T, Lawin P, Breithardt G: Effects of enflurane on the inducibility of ventricular tachycardia. Am J of Cardiol 68: 609, 1991
Selkin SG: Rhinoplasty and general anesthesia. halothane vs enflurane as the agent of choice. Arch Otolaryngol Head Neck Surg 115: 802, 1989

상세보기
Reisner LS, Lippmann M: Ventricular arrhythmias after epinephrine injection in enflurane and in halothane anesthesia. Anesth Analg 54: 468, 1975

상세보기
Smith DC, O'Connell P: The influence of premedication on the occurrence of dysrhythmias during oral surgery. Anaesthesia 42: 882, 1987

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유방확대술 중 발생한 Takotsubo 심근병 1례
A Case Report of Takotsubo Cardiomyopathy During Breast Augmentation 원문보기

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유방확대술 중 발생한 Takotsubo 심근병 1례 A Case Report of Takotsubo Cardiomyopathy During Breast Augmentation 원문보기

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유방확대술 중 발생한 Takotsubo 심근병 1례
A Case Report of Takotsubo Cardiomyopathy During Breast Augmentation 원문보기

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