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+A 36- year- old white woman at 40 week of gestation was admitted to a local obstetric clinic for elective repeated cesarean delivery due to slanting position of the fetus.
+Both her previous and current pregnancy were uncomplicated.
+Her past medical history was unremarkable and no family history of cardiac disease was reported.
+The caesarean delivery was performed following the administration of standard spinal anesthesia.
+During surgery the patient became hypotensive and ephedrine was injected to maintain her blood pressure in the normal range.
+Three hours after delivery of healthy male infant, the patient complained of nausea, increasing dyspnoea and palpitations.
+On physical examination tachycardia with ventricular extra systoles and pulmonary rales were detected.
+Her blood pressure was 80/40 mmHg and demanded the administration of inotropic agents (initially continuous infusion of norepinephrine 0.5 mg/h followed by dobutamine 7 μg/kg/min).
+Owing to worsening of oxygen saturation up to 70 % and gradual deterioration of consciousness, mechanical ventilation was applied and the patient was transferred to intensive care unit.
+Chest X ray indicated pulmonary congestion.
+Emergency computer tomography excluded pulmonary thromboembolism (PE) and confirmed severe pulmonary oedema (Fig.1).
+The patient received loop diuretic, furosemide, at initial daily dose 80 mg, which was progressively reduced.
+The diuretic was discontinued after 12 days of treatment.
+The electrocardiogram disclosed sinus tachycardia with ST- segment elevation of 1,5 mm with negative T waves in aVL and ST- segment depression of 1 mm in II, III, aVF, V5-V6 (Fig.2).
+Laboratory tests showed elevated troponin up to 908 pg/ml (normal value <14 pg/ml), NT- pro BNP 6236 pg/ml (normal value <125 pg/ml).
+The bedside transthoracic echocardiography (TTE) revealed severe left ventricular (LV) systolic dysfunction.
+Therefore the patient was transferred to Intensive Cardiac Therapy Clinic.
+Repeated TTE showed LV ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments.
+Urgent coronary angiography presented normal coronary arteries.
+The diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data.
+After 3 days the patient was weaned from respirator and extubated.
+Following hemodynamic improvement, inotropic agents were tapered gradually.
+Both TTE and magnetic resonance imaging (Figs.3 and ​4) performed on the fifth day showed complete recovery of myocardial function.
+The patient was discharged after 15 days in good overall condition.
+At 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities.