Failing in Reverse: Reverse Takotsubo Cardiomyopathy following a Caesarean Section for twin pregnancy

Dr Pramod Gite, Madhura D Mandlik ,Dr Bhavik Shah

Seth G. S. Medical College and King Edward Memorial Hospital, Mumbai

•24 years, P1L2

•Day 1 post Caesarean Section – Twins

•Intra-operative blood loss ~ 900 ml

•Shortness of breath – Acute onset

•Hypotension

•Investigations:

•Hb – 8.4 gm%, WBC – 28,200/mm3

•SGOT/SGPT – 412 / 159

•CRP – 35.47 mg/L

•Procalcitonin – 0.98 ng/ml

•Transfused 1 PRC, 4 FFP

•Inotropes and Diuretics started

•ECG : Sinus rhythm, ST segment elevation in lead aVR

•Troponin I : 3976 ng/L (normal ref range <17 ng/L)

•2D Echo advised 

•PPCM

•ACS

•Hypotensive shock