"Broken heart" after cesarean delivery. Case report and review of literature

To present a rare case of a multiparous woman undergoing elective cesarean section with apparent symptoms of acute coronary syndrome and who was later diagnosed with Takotsubo cardiomyopathy (TCM; "broken heart syndrome"). To review similar case reports already reported in literature. Literature search on the occurrence of TCM in pregnancy using MEDLINE and Cochrane databases. TCM might occur in women with no known pre-existing cardiomyopathy and uncomplicated pregnancies undergoing cesarean section, especially in combination with the administration of catecholamines/vasoconstrictive substances and possibly also oxytocin and prostaglandins. Since TCM is related to emotional and physical stress, the surroundings during cesarean section should be kept quiet and smooth. Adrenergic stimulants (adrenaline, phenylephrine, ergonovine, ephedrine) and anticholinergics (atropine) should be used with caution and adequate volume substitution prior to the onset of spinal analgesia for the prevention of hypotension should be provided. If signs of an acute coronary syndrome during cesarean section do occur, echocardiography is obligatory for diagnosis of TCM.