Case of Takotsubo cardiomyopathy after tooth extraction - Unusual trigger of a rare syndrome.

We describe a case of Takotsubo cardiomyopathy in a 75-year-old woman after an elective extraction of 10 teeth of the lower jaw using bilateral mandibular anesthesia. The patient complained of shortness of breath and chest pain after 24 h. Coronary angiography showed smooth normal coronary arteries with thrombolysis in myocardial infarction III flow. Left ventriculography demonstrated apical ballooning. Three months later, the patient is symptom-free, with normal left ventricular function. We assume that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy. In our case, we advocate an external catecholamine exposure rather than an internal catecholamine excess. We need more vigilance when assessing such patients. <Learning objective: We describe a stress-induced cardiomyopathy with late symptom development despite an uncomplicated tooth extraction. There was only one case of Takotsubo cardiomyopathy with acute symptoms described in the literature, although after complicated tooth extraction. It could be interesting for physicians that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy.>.