━━ Introduction. Flexible bronchoscopy is a safe, widely applied procedure for the diagnosis of airway diseases or lung abnormalities. In cases of the elderly, however, we should take account of uncommon adverse events such as Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is recognized as stress-induced cardiomyopathy preceded by emotional or physical stress, which is typically associated with transient dyskinesia or akinesia of the left ventricular apical wall with normal findings or hyperkinesis of the basal wall. Flexible bronchoscopy can give elderly patients so much stress that it is at risk for developing Takotsubo cardiomyopathy. Case Reports.We report a series of cases diagnosed as Takotsubo cardiomyopathy during or after flexible bronchoscopy as follows. Case 1: A woman aged 85 developed Takotsubo cardiomyopathy one day after flexible bronchoscopy. She was associated with arrhythmias, and died partly because of heart failure and progression of lung cancer. Case 2: A woman aged 85 developed Takotsubo cardiomyopathy 6 days after the procedure. Her case was associated with intraventricular thrombus and was treated with anticoagulant. Case 3: A man aged 85 developed Takotsubo cardiomyopathy 6 days after the procedure. His condition was associated with acute heart failure and was treated with non-invasive positive-pressure ventilation. He was also treated with anticoagulant, but developed cerebral embolism and led to right hemiplegia. Case 4: A man aged 78 developed Takotsubo cardiomyopathy during the procedure. He had no complications and was treated for lung cancer with irradiation. Conclusion. Takotsubo cardiomyopathy is an uncommon, but an important adverse event of flexible bronchoscopy on the elderly, partly because it can lead to severe events such as pump failure, arrhythmia, or thromboembolism. Once Takotsubo cardiomyopathy develops, activities of daily living and cognitive functions may decline before recovering from it and it can be attributed to their poor prognosis, especially in the frail elderly. To prevent Takotsubo cardiomyopathy during bronchoscopy, we should prevent emotional and physical stress with administration of the appropriate sedative or anti-anxiety medicine. (JJSRE. 2017;39:333-342) KEY WORDS━━ Flexible bronchoscopy, Takotsubo cardiomyopathy, Elderly
