‘Is the Patient Clear for Surgery?’ Takotsubo Cardiomyopathy Presenting as T-Wave Inversions in a Pre-Operative EKG: A Case Report

Authors

Muhammad Hammad Sharif, Rochester General Hospital, Rochester, New YorkFollow
Madeeha Khaleeque, Khyber Teaching Hospital, Peshawar, PakistanFollow
Syed Faiz Abbas, Sands Constellation Heart Institute, Rochester General Hospital, Rochester, New YorkFollow
Gaurav Sharma, Sands Constellation Heart Institute, Rochester General Hospital, Rochester, New YorkFollow
Aditya Sanjeevi, Rochester General Hospital, Rochester, New YorkFollow
Muhammad Hassan Jan, Hayatabad Medical Complex, Peshawar, PakistanFollow
Atif Ahmed, Khyber Teaching Hospital, Peshawar, PakistanFollow

Author Credentials

1. Muhammad Hammad Sharif. Internal Medicine. Rochester General Hospital, Rochester, New York, United States
2. Madeeha Khaleeque. Internal Medicine. Khyber Teaching Hospital, Peshawar, Pakistan
3. Syed F. Abbas. Sands Constellation Heart Institute. Rochester General Hospital, Rochester, New York, United States
4. Gaurav Sharma. Sands Constellation Heart Institute. Rochester General Hospital, Rochester, New York, United States
5. Aditya Sanjeevi. Internal Medicine. Rochester General Hospital, Rochester, New York, United States
6. Muhammad Hassan Jan: Internal Medicine. Hayatabad Medical Complex, Peshawar, Pakistan
7. Atif Ahmed: Internal Medicine. Khyber Teaching Hospital, Peshawar, Pakistan

Author ORCID Identifier

Muhammad Hammad Sharif: https://orcid.org/0009-0007-2261-6809

Abstract

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for TC. The findings of TTE combined with unremarkable delta troponin and no chest pain pointed towards TC as opposed to a true coronary plaque rupture event. Given the urgency of the surgery, it was decided to defer a coronary angiogram as it would not change the management and would cause an unnecessary delay in the surgery. Repeat EKG showed partial resolution of T-wave inversions with no progressive dynamic ischemic changes and she successfully underwent surgery without any delay. TC can manifest with acute dynamic EKG changes resembling an acute coronary event. It is essential to differentiate between the two entities to avoid unnecessary surgery delays and prevent exposure to invasive cardiac testing pre-operatively. Early TTE is an important clinical tool to differentiate TTE from acute coronary syndrome (ACS) and guide medical decision-making.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Sharif M, Khaleeque M, Abbas S, Sharma G, Sanjeevi A, Jan MH, Ahmed A. ‘Is the Patient Clear for Surgery?’ Takotsubo Cardiomyopathy Presenting as T-Wave Inversions in a Pre-Operative EKG: A Case Report. Advances in Clinical Medical Research and Healthcare Delivery. 2026; 6(1):28-33. doi: 10.53785/2769-2779.1324.