Postoperative Takotsubo Syndrome Presenting with Malignant Ventricular Arrhythmia: A Case Report

Abstract

Background: Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy characterized by transient left ventricular systolic dysfunction, typically triggered by emotional or physical stress. While usually reversible, TTS can be complicated by severe events, with ventricular arrhythmias representing a particularly serious risk linked to increased morbidity and mortality. Case Summary: We report a 63-year-old postmenopausal woman with hypertension and type 2 diabetes mellitus who underwent elective cholecystectomy under general anesthesia without intraoperative complications. Two days postoperatively, she developed persistent chest discomfort followed by sudden-onset palpitations. Electrocardiography revealed sustained monomorphic ventricular tachycardia at 180 bpm causing hemodynamic instability, which required urgent pharmacological and electrical intervention. Cardiac biomarkers showed a peak troponin of 1.2 ng/mL, and QTc was prolonged at 510 ms. Transthoracic echocardiography demonstrated a left ventricular ejection fraction (LVEF) nadir of 35%, and cardiac MRI confirmed apical ballooning and myocardial edema, consistent with TTS. The patient was stabilized with anti-arrhythmic therapy and beta-blockers, and discharged after seven days. At follow-up, LVEF normalized to 52%, troponin returned to baseline, and no arrhythmic events occurred. Discussion: This case underscores the risk of malignant ventricular arrhythmias in TTS, particularly in the perioperative context where surgical stress can act as a trigger. The arrhythmogenic mechanism likely involved sympathetic overdrive, postoperative inflammatory responses, and repolarization abnormalities. Prompt recognition and timely management of arrhythmias are crucial to prevent life-threatening outcomes. Conclusion: Although TTS is generally self-limiting, it can be complicated by potentially fatal ventricular arrhythmias. Clinicians should maintain a high index of suspicion in postmenopausal women presenting with acute chest pain or arrhythmia following recent surgery, as early diagnosis and intervention are essential to improving prognosis.