Key result
Anesthesia induction linked to Takotsubo cardiomyopathy via the trigeminocardiac reflex in a trigeminal neuralgia patient.
Why the study?
Although sympathetic overstimulation plays a primary role in Takotsubo syndrome pathogenesis, these correlates are less easily identified during anesthesia.
Case Report (n=1)
No
Chronic pain in trigeminal neuralgia may lead to adrenergic hyperactivation, promoting Takotsubo syndrome during general anesthesia induction via the trigeminocardiac reflex.
Anesthesia induction in trigeminal neuralgia may precipitate Takotsubo cardiomyopathy; leaves open trigeminocardiac reflex frequency in larger series.
BACKGROUND: Takotsubo syndrome (TS) represents a form of nonischemic cardiomyopathy characterized by sudden and temporary weakening of the myocardium. Many data suggest a primary role for sympathetic overstimulation in its pathogenesis. Nevertheless, these correlates are less easily identified during anesthesia. OBSERVATIONS: A 50-year-old female patient with a 4-year history of drug-resistant left trigeminal neuralgia. She was scheduled for surgical microvascular decompression. In the operating room, after induction of general anesthesia and oral intubation, the electrocardiogram revealed a significant ST segment elevation along with a sudden decrease in systolic blood pressure and heart rate. Administration of atropine caused a conversion into ventricular tachycardia. The advanced cardiac life support protocols were applied with prompt defibrillation and rapid recovery at sinus rhythm. A transthoracic echocardiogram revealed apical akinesia with ballooning of the left ventricle with a reduction of systolic function. An emergency coronary arteriography was performed, showing normal epicardial coronary vessels. After 4 days, echocardiography revealed normalization of the left ventricular function with improvement of the ejection fraction. LESSONS: In patients affected by trigeminal neuralgia, chronic pain can lead to a state of adrenergic hyperactivation, which can promote TS during the induction of general anesthesia, probably through the trigeminocardiac reflex.
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Mazzaglia et al. (2023) conducted a case report in Trigeminal neuralgia and Takotsubo cardiomyopathy (n=1). General anesthesia induction and intubation was evaluated on Development of Takotsubo cardiomyopathy. A 50-year-old female with trigeminal neuralgia developed Takotsubo cardiomyopathy during the induction of general anesthesia, likely triggered by the trigeminocardiac reflex.
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