**8.1. Sign and symptoms**

It is rare, usually occurs in postmenopausal women associated with stress and chest pain. ECG changes may include prolonged QTc interval which resolve in 1–2 days, ST-T changes, Q waves, resolve by discharge from hospital, and T inversion resolves slowly.

This condition is also known as apical ballooning syndrome and broken heart syndrome or stress-induced cardiomyopathy. Echocardiography shows akinesia of apical or midventricular segments leading to systolic dysfunction. The normal basal segments become hypercontractile, giving a ballooned-out appearance of the apical or mid-cavity segments. Ballooning may lead to altered spatial relationships between mitral leaflets and subvalvular apparatus, which may result in MR and dynamic LVOTO causing SAM.

Reversible myocardial ischaemia is seen on myocardial perfusion imaging, and positron emission tomography and magnetic resonance imaging confirm LV dysfunction. Biopsy may show lymphocytic infiltrates. Plasma levels of brain natriuretic peptide, catecholamines, cardiac enzymes and metanephrine are found to be elevated.

#### **8.2. Management**

Optimal therapy is yet to be defined [9]. Beta blockers, diuretics, and ACE inhibitor and vasodilators have been used. Adrenergic agonists and antiadrenergic therapy (beta adrenergic blockers or alpha 2 agonists) and QT prolonging medications are to be avoided.

**10. Conclusion**

**Abbreviations**

AHA American Heart Association

AS aortic stenosis

CO cardiac output

EF ejection fraction

CAD coronary artery disease CHF congestive heart failure

CMR cardiac magnetic resonance

CVP central venous pressure DCM dilated cardiomyopathy

EMB endomyocardial biopsy

HCM hypertrophic cardiomyopathy

ICD implantable cardioverter-defibrillator

IABP intra-arterial blood pressure

ARSA American Society of Regional Anaesthesia

CTR-D cardiac resynchronisation therapy device

ARVC arrhythmogenic right ventricular cardiomyopathy

Nowadays, cardiomyopathies are being identified increasingly as a result of improved means of detection with echocardiographic examination and an increase in the ageing population group. In addition, the presentation of this disease is varied. It may be sudden or already well known to the patient. Anaesthesia administration for patients with cardiomyopathy can lead to perioperative morbidity and mortality during elective or, more importantly in emergency surgeries. Therefore, anaesthesia and postoperative care have to be carefully titrated, planned, and monitored for every patient, for which we need a thorough understanding of the pathophysiology of cardiomyopathies. The best approach would be a multidisciplinary team that includes anaesthetists, cardiologists, and surgeons. As anaesthesiologists, we have to expand our horizon from operating room to ICU with a thorough understanding of non-invasive and invasive monitoring methods and a basic knowledge of transthoracic echocardiography.

Current Perspectives on Cardiomyopathies http://dx.doi.org/10.5772/intechopen.79529 123
