Takotsubo Cardiomyopathy in Pregnancy: A Rare but Serious Condition Requiring Dedicated ICU Care – Collaborating Across Societies to Advance OB Critical Care & Cardio-obstetrics

Issue 36 | Volume 1

Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy or “broken heart syndrome,” is a transient form of heart failure characterized by reversible left ventricular dysfunction in the absence of coronary artery obstruction. While typically associated with older, postmenopausal women, TTC has increasingly been reported in pregnant and postpartum patients—a population in which presentation is often more complex, diagnostic tools are limited, and both maternal and fetal lives are at stake. 

In pregnant patients, TTC is often triggered by physical or emotional stressors such as labor, preeclampsia, postpartum hemorrhage, or surgical delivery. Pathophysiology involves a catecholamine surge that leads to myocardial stunning and characteristic apical ballooning. Hormonal shifts in pregnancy may further sensitize the myocardium to catecholaminergic injury.1,2

Clinical presentation can closely mimic acute coronary syndrome (ACS), with chest pain, dyspnea, and ECG changes such as ST-segment elevations or T-wave inversions. Troponin elevations are common. Echocardiography typically reveals apical ballooning with basal hyperkinesis, which helps distinguish TTC from peripartum cardiomyopathy, where the ventricular dysfunction is more global and less reversible.3,4 Cardiac MRI may provide additional clarity when radiation exposure is a concern or coronary angiography is not feasible.

While often self-limiting, TTC can result in serious complications: heart failure, arrhythmias, thrombus formation, and even sudden cardiac death.5 These risks, coupled with the physiological demands of pregnancy, require high clinical vigilance and rapid multidisciplinary intervention. Fetal complications, including hypoxia and growth restriction, can arise from maternal hemodynamic instability.6

Supportive care in a dedicated obstetric ICU setting is ideal. This includes careful fluid and medication management, continuous maternal- fetal monitoring, and access to high- level cardiovascular, obstetric, and neonatal expertise. Due to teratogenic risks, medications such as beta- blockers (atenolol) and anticoagulants must be selected with caution. In select cases, mechanical support may be necessary.

As maternal morbidity and critical illness rise across the U.S., the importance of interdisciplinary collaboration and infrastructure for maternal critical care cannot be overstated.

This year’s SOAP Annual Meeting in Portland marked a significant milestone in promoting these goals. For the first time, a joint SOCCA-SOAP panel spotlighted the evolving field of cardio-obstetrics and the critical care needs of pregnant patients. This cross-society collaboration reflects our shared mission to elevate maternal care through education, research, and innovation.

I’m honored to be Chair of the Obstetric Critical Care Medicine (OB-CCM) Task Force within the SOCCA Clinical Practice Committee and recently appointed Co-Chair of the SOCCA Annual Meeting Oversight Committee. Through these roles—and continued collaboration between SOCCA and SOAP—we aim to grow the field of OB critical care and ensure that critically ill pregnant patients receive the specialized, expert-driven care they deserve.

REFERENCES:

1. Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008;124(3):283-292.
2. Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373(10):929-938.
3. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako- Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408-417.
4. Bello N, Rendon IS, Arany Z. The relationship between pre- eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013;62(18):1715-1723.
5. Sharkey SW, Windenburg DC, Lesser JR, et al. Natural history and expansive clinical profile of stress (Tako-Tsubo) cardiomyopathy. J Am Coll Cardiol. 2010;55(4):333-341.
6. Yassaee F, Talebian M, Shahhosseini F. Peripartum Takotsubo cardiomyopathy: diagnostic challenges and clinical outcomes. Iran J Med Sci. 2021;46(2):171-176.
7. Kilpatrick SJ, Matthay MA, Stevenson DK. Critical care obstetrics: the evolving need for specialized maternal ICUs. Am J Obstet Gynecol. 2016;215(2):123–128.
8. Kilpatrick SJ, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2019;221(4):B5–B9.