{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:09Z","timestamp":1756323609403,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,2]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Reverse Takotsubo cardiomyopathy is a rare variant of cardiomyopathy, characterised by left ventricular basal and midventricular akinesis with sparing of the apex. A previously well woman in her 30s with current social stressors was noted to be bradycardic following a high spinal block at elective caesarean section. After administration of glycopyrrolate, she became acutely dyspnoeic, tachycardic and hypertensive. Serial ECGs demonstrated ST depression in inferior and anterolateral leads, and troponin was elevated. An echocardiogram revealed akinesis in the basal to mid walls and hyperdynamic function of the apex of the left ventricle with reduced ejection fraction. Initial management measures included intravenous magnesium, which was commenced in response to the tachycardia and hypertension. She was subsequently commenced on bisoprolol. She was discharged after 3\u2009days. Her follow-up echocardiogram 4\u2009weeks later was normal. Reverse Takotsubo cardiomyopathy, likely secondary to glycopyrrolate on the background of social stressors, is a rare cause of heart failure peripartum.<\/jats:p>","DOI":"10.1136\/bcr-2025-265777","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T07:40:24Z","timestamp":1750318824000},"page":"e265777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Reverse Takotsubo cardiomyopathy at caesarean section following administration of glycopyrrolate for bradycardia secondary to high spinal block"],"prefix":"10.1136","volume":"18","author":[{"given":"Kate","family":"Mannolini","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Ramsay Health Care Limited, Joondalup, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Ramsay Health Care Limited, Joondalup, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Brushett","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Ramsay Health Care Limited, Joondalup, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"McCartney","sequence":"additional","affiliation":[{"name":"Anaesthetics, Ramsay Health Care Limited, Joondalup, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"2025082712061611000_18.6.e265777.1","unstructured":"Reeder GS , Prasad AP . Clinical manifestations and diagnosis of stress (takotsubo) cardiomyopathy. In: McKenna WJ , Dardas TF , eds. UpToDate. Waltham (MA): UpToDate Inc, 2024. Available: https:\/\/www.uptodate.com\/contents\/clinical-manifestations-and-diagnosis-of-stress-takotsubo-cardiomyopathy?search=takotsubo+cardiomyopathy&source=search_result&selectedTitle=1%7E89&usage_type=default&display_rank=1"},{"key":"2025082712061611000_18.6.e265777.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00059-010-3339-x"},{"key":"2025082712061611000_18.6.e265777.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.055854"},{"key":"2025082712061611000_18.6.e265777.4","unstructured":"Reeder GS , Prasad AP . Management and prognosis of stress (takotsubo) cardiomyopathy. In: McKenna WJ , Dardas TF , eds. UpToDate. Waltham (MA): UpToDate Inc, 2023. Available: https:\/\/www.uptodate.com\/contents\/management-and-prognosis-of-stress-takotsubo-cardiomyopathy?search=takotsubo+cardiomyopathy&source=search_result&selectedTitle=2%7E89&usage_type=default&display_rank=2"},{"key":"2025082712061611000_18.6.e265777.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406761"},{"key":"2025082712061611000_18.6.e265777.6","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/JOACC.JOACC_38_23","article-title":"Takotsubo Cardiomyopathy in Pregnancy: A Focused Review","volume":"13","author":"Garg","year":"2023","journal-title":"J Obstet Anaesth Crit Care"},{"key":"2025082712061611000_18.6.e265777.7","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare12161602","article-title":"Takotsubo Syndrome: Differences between Peripartum Period and General Population","volume":"12","author":"Tzerefos","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"2025082712061611000_18.6.e265777.8","unstructured":"Valente AM , Economy K . Maternal adaptations to pregnancy: cardiovascular and hemodynamic changes. In: Lockwood CJ , Gersh BJ , Barss VA , eds. UpToDate. Waltham (MA): UpToDate Inc, 2024. Available: https:\/\/www.uptodate.com\/contents\/maternal-adaptations-to-pregnancy-cardiovascular-and-hemodynamic-changes?search=physiological%20changes%20in%20pregnancy&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H22"},{"key":"2025082712061611000_18.6.e265777.9","unstructured":"Australian Institute of Health and Welfare . Australia\u2019s mothers and babies. AIHW cat. no. PER 101. Canberra (ACT): Australian Institute of Health and Welfare; 2025. Available: https:\/\/www.aihw.gov.au\/getmedia\/bf03fda0-6d37-46f3-8ba6-9c3ebadc26f8\/australia-s-mothers-and-babies.pdf?v=20250103131556&inline=true"},{"key":"2025082712061611000_18.6.e265777.10","unstructured":"DeCara JM , Lang RM , Davis MB . Management of heart failure during pregnancy. In: Colucci WS , Lockwood CJ , Dardas TF , eds. UpToDate. 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