[A Case of Lethal Atypical Takotsubo Cardiomyopathy Detected by Sustained Ventricular Arrhythmia Just before Induction of General Anesthesia].

A 73 year-old female patient was scheduled for lumbar peritoneal shunt three weeks after subarachnoid hemorrhage. Before induction of general anesthesia, her ECG showed ventricular tachycardia (VT) without any complaints. Administration of lidocaine and direct current shocks were ineffective and VT continued. Operation was postponed and transthoracic echocardiography revealed diffuse hypokinesis. Emergent angiogram revealed midventricular ballooning with slight hypoki- nesis in basal and apical regions without significant coronary artery lesion. Atypical takotsubo cardiomyopathy was diagnosed. Intra aortic balloon pumping and continuous infusion of amiodaron and catecholamines were started, but her ventricular motion decreased. She died next morning. In this case, the physical/psychological stress before operation was con- sidered to be a trigger of the event. Although tako- tsubo cardiomyopathy is usually a transient disease, it must be kept in mind that an acute and lethal case with no response to any treatment like ours exists.