Cardiogenic Shock Secondary to Tako-tsubo Syndrome After Debridement of Malignant Endobronchial Obstruction

Transient left ventricular (LV) dysfunction syndrome, or Tako-tsubo syndrome, occurs following intense emotional or physical stress and simulates the clinical presentation of, an acute myocardial infarction. We report a case of a 77-year-old man with esophageal adenocarcinoma with local invasion of the central airways who underwent rigid bronchoscopy for tumor debridement folio-wed by placement of a stent. Postoperatively, cardiogenic shock developed and echocardiography, revealed akinesis of the LV apex with an ejection fraction (EF) of 15%. Emergent coronary 7 angiography revealed no significant coronary artery disease. The patient required intraaortic balloon counterpulsation and pressors. Seventy-two hours later, repeat echocardiography showed in EF of 45% with improvement in apical function, and the patient was discharged home in stable condition shortly thereafter. A 5-month folllow-up echocardiogram revealed in EF > 55%, and the patient enjoyed an excellent performance status. (CHEST 2009; 135:217-220)