{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:22:29Z","timestamp":1783009349204,"version":"3.54.5"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Takotsubo syndrome or \u201cbroken heart syndrome,\u201d is an uncommon but increasingly recognized condition that can mimic acute coronary syndrome and is characterized by transient regional left ventricular dysfunction, often with apical ballooning. Perioperative physiological stress, catecholamine surges, and vasopressor exposure are recognized triggers. This case describes suspected perioperative takotsubo syndrome in a high-risk surgical patient and emphasizes the need for vigilance and early recognition. A 66-year-old woman with hypertension, type B aortic dissection, prior stroke, carotid disease, hyperlipidemia, and tobacco use presented with a left intertrochanteric fracture requiring operative repair. During anesthesia induction, she developed profound hypotension and bradycardia refractory to fluids and vasopressors, resulting in procedure cancellation. Her initial echocardiogram demonstrated normal systolic function without regional wall motion abnormalities. Surgery was rescheduled the following day; however, she experienced pulseless electrical activity arrest postoperatively. Advanced cardiovascular life support with epinephrine achieved return of spontaneous circulation. A post-arrest echocardiogram demonstrated new mid-apical hypokinesis with an ejection fraction of 35%\u201340%, most consistent with takotsubo syndrome in the clinical context. She was treated with guideline-directed medical therapy, including beta-blockade and an ACE inhibitor, with subsequent stabilization and discharge. Formal coronary angiography was not performed, and the patient was lost to cardiology follow-up, limiting definitive exclusion of obstructive coronary artery disease and confirmation of left ventricular recovery. This case illustrates the multifactorial perioperative contributors to takotsubo syndrome and highlights the importance of recognizing warning features, including recurrent hypotension, catecholamine exposure, labile hemodynamics, and high-risk cardiovascular comorbidity.<\/jats:p>","DOI":"10.1177\/2050313x261464290","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:47:54Z","timestamp":1782820074000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Takotsubo syndrome triggered by perioperative and post-resuscitation stress: Case report"],"prefix":"10.1177","volume":"14","author":[{"given":"Roshan","family":"Tom","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3650-705X","authenticated-orcid":false,"given":"Sean","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Kuang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariadna","family":"Robledo","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Teegarden","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Y-Hassan S De Palma R. Contemporary review on the pathogenesis of takotsubo syndrome: the heart shedding tears: norepinephrine churn and foam at the cardiac sympathetic nerve terminals. Int J Cardiol 2017; 228: 528\u2013536. https:\/\/doi.org\/10.1016\/j.ijcard.2016.11.086","DOI":"10.1016\/j.ijcard.2016.11.086"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Y-Hassan S Tornvall P. Epidemiology pathogenesis and management of takotsubo syndrome. Clin Auton Res 2018; 28: 53\u201365. https:\/\/doi.org\/10.1007\/s10286-017-0465-z","DOI":"10.1007\/s10286-017-0465-z"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Templin C Ghadri JR Diekmann J et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373: 929\u2013938. https:\/\/doi.org\/10.1056\/NEJMoa1406761","DOI":"10.1056\/NEJMoa1406761"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"P\u00e4tz T Santoro F Cetera R et al. Trigger-associated clinical implications and outcomes in takotsubo syndrome: results from the multicenter GEIST registry. J Am Heart Assoc 2023; 12: Article e028511. https:\/\/doi.org\/10.1161\/JAHA.122.028511","DOI":"10.1161\/JAHA.122.028511"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Ghadri J-R Wittstein IS Prasad A et al. International expert consensus document on takotsubo syndrome (part I): clinical characteristics diagnostic criteria and pathophysiology. Eur Heart J 2018; 39: 2032\u20132046. https:\/\/doi.org\/10.1093\/eurheartj\/ehy076","DOI":"10.1093\/eurheartj\/ehy077"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Sattar Y Siew KSW Connerney M et al. Management of takotsubo syndrome: a comprehensive review. Cureus 2020; 12: Article e6556. https:\/\/doi.org\/10.7759\/cureus.6556","DOI":"10.7759\/cureus.6556"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Matta A Delmas C Campelo-Parada F et al. Takotsubo cardiomyopathy. Rev Cardiovasc Med 2022; 23: 38. https:\/\/doi.org\/10.31083\/j.rcm2301038","DOI":"10.31083\/j.rcm2308281"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Izumo M Akashi YJ. Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications. Cardiovasc Diagn Ther 2018; 8: 90\u2013100. https:\/\/doi.org\/10.21037\/cdt.2017.07.03","DOI":"10.21037\/cdt.2017.07.03"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Ono R Falc\u00e3o LM. Takotsubo cardiomyopathy systematic review: pathophysiologic process clinical presentation and diagnostic approach to takotsubo cardiomyopathy. Int J Cardiol 2016; 209: 196\u2013205. https:\/\/doi.org\/10.1016\/j.ijcard.2016.02.012","DOI":"10.1016\/j.ijcard.2016.02.012"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Hessel EA. Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review. Can J Anaesth 2016; 63: 1059\u20131074. https:\/\/doi.org\/10.1007\/s12630-016-0680-4","DOI":"10.1007\/s12630-016-0680-4"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Kurisu S Inoue I Kawagoe T et al. Tako-tsubo cardiomyopathy after successful resuscitation of out-of-hospital cardiac arrest. J Cardiovasc Med 2010; 11: 465\u2013468. https:\/\/doi.org\/10.2459\/JCM.0b013e3283339eb9","DOI":"10.2459\/JCM.0b013e3283339eb9"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Ved YP Sharan S Bandebuche A et al. Perioperative takotsubo stress cardiomyopathy during endoscopic spinal surgery: a case report. JBJS Case Connect 2024; 14: 12\u201325. https:\/\/doi.org\/10.2106\/JBJS.CC.24.00031","DOI":"10.2106\/JBJS.CC.24.00031"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"Komamura K Fukui M Iwasaku T et al. Takotsubo cardiomyopathy: pathophysiology diagnosis and treatment. World J Cardiol 2014; 6: 602\u2013609. https:\/\/doi.org\/10.4330\/wjc.v6.i7.602","DOI":"10.4330\/wjc.v6.i7.602"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Nazir S Lohani S Tachamo N et al. Takotsubo cardiomyopathy associated with epinephrine use: a systematic review and meta-analysis. Int J Cardiol 2017; 229: 67\u201370. https:\/\/doi.org\/10.1016\/j.ijcard.2016.11.266","DOI":"10.1016\/j.ijcard.2016.11.266"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"Gragnano F Guarnaccia N Cesaro A et al. Beyond the left ventricle: why the right heart matters in takotsubo syndrome. Int J Cardiol 2025; 428: Article 133134. https:\/\/doi.org\/10.1016\/j.ijcard.2025.133134","DOI":"10.1016\/j.ijcard.2025.133134"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Arcari L N\u00fa\u00f1ez Gil IJ Stiermaier T et al. Gender differences in takotsubo syndrome. J Am Coll Cardiol 2022; 79: 2085\u20132093. https:\/\/doi.org\/10.1016\/j.jacc.2022.03.366","DOI":"10.1016\/j.jacc.2022.03.366"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261464290","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X261464290","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261464290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:49:28Z","timestamp":1783007368000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X261464290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":16,"alternative-id":["10.1177\/2050313X261464290"],"URL":"https:\/\/doi.org\/10.1177\/2050313x261464290","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X261464290"}}