SHM Converge Scientific Abstract ePoster Gallery-Post-Hepatocellular Carcinoma Microwave Ablation Takotsubo Cardiomyopathy

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This case report describes a rare episode of Takotsubo cardiomyopathy occurring after microwave ablation of hepatocellular carcinoma in a 58-year-old man with hepatitis C, alcoholic cirrhosis, HCC, and asthma. He underwent elective ethiodol embolization and microwave ablation for a presumed hepatic malignancy. Soon after the procedure, he developed severe shortness of breath, oxygen desaturation into the low 80s on room air, and required BiPAP. Initial chest X-ray did not show pulmonary edema, but his lactate was elevated at 4.6, and he received IV fluid boluses and maintenance fluids.<br /><br />By the next morning, his condition worsened despite resuscitation, with lactate rising to 9.7 and jugular venous distention becoming evident. A transthoracic echocardiogram showed diffuse apical hypokinesis, consistent with Takotsubo cardiomyopathy. A prior echocardiogram two months earlier had shown normal left ventricular function, supporting an acute and reversible process. He was treated with intravenous diuretics, improved clinically, and was transitioned to oral diuretics along with carvedilol and lisinopril. He was discharged with cardiology follow-up, and repeat echocardiography five months later demonstrated recovery of apical wall function.<br /><br />The discussion emphasizes that Takotsubo cardiomyopathy, also called “broken heart syndrome,” is most often associated with emotional stress but can also follow major physical stressors such as surgery. It accounts for a small proportion of patients initially thought to have acute coronary syndrome or troponin elevation. Because its symptoms can mimic acute decompensated heart failure, clinicians should include Takotsubo cardiomyopathy in the differential diagnosis for postoperative patients who develop dyspnea, hypoxia, volume overload, or other cardiopulmonary symptoms.

Asset Subtitle

William Giesing

Meta Tag

Author List Miguel Villamil, William Giesing

Category Clinical Vignettes

Concept Takotsubo Cardiomyopathy

Concept Apical Hypokinesis

Concept Heart Failure

Concept Acute Coronary Syndrome

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization Methodist Health System

Presenting Author William Giesing

Track Adult

Keywords

Takotsubo cardiomyopathy

microwave ablation

hepatocellular carcinoma

case report

postoperative dyspnea

acute heart failure

apical hypokinesis

echocardiography

cirrhosis

broken heart syndrome

Takotsubo Cardiomyopathy

Apical Hypokinesis

Heart Failure

Acute Coronary Syndrome

Echocardiography