PMC4377004_01
Normal heart (A) and Tako-Tsubo sign (B) with apical ballooning (end-systolic view).
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Fig1
Resting ECG of the patient.
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Fig2
Preoperative anaesthesia evaluation including ECG (Figure 2) and blood analysis was unremarkable.
Original case TEE sequence in anaesthesia #4. A. acute onset of left ventricular dysfunction/considerable hypokinesia (reduced contractility: outer circle: diastole; inner circle: systole). B. after successful therapeutic intervention: normal left ventricular function/no considerable wall motion abnormalities (normal contractility: outer circle: diastole; inner circle: systole).
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Fig3
TEE (Figure 3A). This considerable haemodynamic depression was instantly treated by application of a fluid bolus and repetitive vasopressor support (Sigma 100 mug norepinephrine i.v.). Within few minutes haemodynamics stabilized and the described echocardiographic symptoms of left-ventricular function disorder diminished (Figure 3B). TEE similar to Figure 3A). These symptoms resembled the situation described in anaesthesia #4 but haemodynamic depression and contractile dysfunction were more pronounced and required intermittent vasopressor and inotropic support as well as a fluid bolus (  approx. 1 mg norepinephrine and 100 mug epinephrine).