Peripartum takotsubo cardiomyopathy after an emergency Caesarean delivery—diagnosis and specialist management

We report the case of a 32-yr-old primiparous patient who underwent an emergency Caesarean delivery and subsequently developed peripartum takotsubo cardiomyopathy necessitating transfer to a tertiary referral critical care unit and the heart failure service. Takotsubo cardiomyopathy, also called stress cardiomyopathy, is a form of left ventricular dysfunction with distinct wall motion abnormalities in the absence of coronary artery disease. It is considered extremely rare in the peripartum period, most commonly presenting in postmenopausal women with increased myocardial sensitivity to excess circulating catecholamines as a potential role in the pathogenesis. In the peripartum period, the physiological cardiovascular adaptations of pregnancy superimposed on psychosocial stressors is the assumed pathogenesis. Unexplained dyspnoea in the peripartum period should prompt early transthoracic echocardiography and specialist critical care and heart failure team input, where appropriate. This case highlights the need to consider rare cardiac causes of acute dyspnoea and demonstrates the value of point-of-care transthoracic ultrasound for prompt bedside assessment, aiding diagnosis and management. Clinical, echocardiographic, and radiological features can aid differentiating takotsubo cardiomyopathy from other differential diagnoses. Specialist multidisciplinary teams comprised of obstetricians, anaesthetists, intensivists, cardiologists, and specialist services, such as lactation and psychology services, should be available to care for these patients and a holistic approach needs to be adopted to counsel and address the psychological sequelae after such a diagnosis and appropriately plan for future pregnancies.