Takotsubo Syndrome induced by sclerotherapy: A case report

Takotsubo Syndrome (TS), also known as stress cardiomyopathy, is an acute, reversible left ventricular dysfunction often triggered by emotional or physical stressors. Although most cases are associated with emotional distress, TS has also been reported following medical procedures. We present the case of a 40-year-old female who developed TS immediately after undergoing sclerotherapy with Polidocanol for pelvic varices. Shortly after the injection, she experienced acute chest pain, dyspnea, tachycardia, and hypertension. Electrocardiography showed T-wave inversion, and echocardiography revealed a severely reduced left ventricular ejection fraction (23 %) with apical ballooning. Coronary angiography ruled out obstructive coronary disease, consistent with a diagnosis of Polidocanol-induced Takotsubo Syndrome. The patient required inotropic support in the Intensive Care Unit and an intra-aortic balloon pump, with cardiac recovery within seven days. Although rare, TS should be considered in patients experiencing acute cardiovascular symptoms after sclerotherapy. The pathophysiological mechanisms remain unclear but may involve endothelial irritation, systemic inflammation, and autonomic dysregulation. This specific case is unique due to the patient’s age, the severity of the cardiac dysfunction and the time of symptom onset. Awareness of this complication is crucial for early recognition and appropriate management, particularly in high-risk patients undergoing minimally invasive vascular procedures in an ambulatory care unit.