Delayed Takotsubo Cardiomyopathy Caused by Excessive Exogenous Epinephrine Administration After the Treatment of Angioedema

Patankar, Gautam R.; Donsky, Michael S.; Schussler, Jeffrey M.

doi:10.1080/08998280.2012.11928833

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…Complete recoveryGicquel-Chlemmer et al 11 48, MElective shoulder repair1 mgIAApicalCardiogenic shock, fatalMurthy et al 12 49, MBradycardia, hypotension0.3 mgIVMidComplete recoveryAlyonan et al 13 50, FAnaphylaxis to insect bite, unspecified1 mgIVApicalComplete recoveryEsnault et al 14 49, FHypotension during laparoscopic cholecystectomy1 mgIVMid, basalCardiogenic shock requiring extra-corporeal membrane oxygenation. Complete recoveryKhoeuiry et al 15 44, FAnaphylaxis to iodine contrast1 mgIMMid, basalComplete recoverySundbøll et al 16 67, MElective biopsy of left maxillary sinus tumour (Moffat’s solution: adrenaline and cocaine packing)3.2 mgINMid, apicalComplete recoveryKajander et al 17 31, FExercise-induced anaphylaxis0.3 mgIVBasalComplete recoveryPatankar et al 18 44, FAngioedema (ACE inhibitor)3.3 mgSCApicalComplete recoveryHarle et al 19 39, FInadvertent injection (in context of adrenal stress testing)1 mgIVMid, basalComplete recovery…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report

Spina

Song

Kathir

et al. 2018

European Heart Journal - Case Reports

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Introduction Stress cardiomyopathy, also known as takotsubo syndrome, is characterized by transient left ventricular dysfunction not attributable to obstructive epicardial coronary artery disease. Several pathological mechanisms have been proposed, including multivessel coronary artery vasospasm, coronary microcirculatory dysfunction, and excess catecholamine secretion. Case presentation A 68-year-old male presented to our institution for elective surgical removal of a cutaneous basal cell carcinoma on the right side of his face. Within minutes following the administration of local anaesthesia, the patient developed severe hypertension, tachycardia, ST-segment elevation on the electrocardiogram, and non-sustained broad-complex tachycardia. Urgent cardiac catheterization revealed non-obstructive coronary artery disease and left ventriculography demonstrated apical hypokinesia and moderate systolic dysfunction consistent with the takotsubo syndrome. On review of the medications administered, it was noted that an unintentionally large dose of adrenaline (4mg) had been injected subcutaneously with lignocaine. He was monitored in the coronary care and recovered fully with supportive care only. Bisoprolol was initiated on day 1 post procedure. On follow-up one month later, his left ventricular function had normalized. Discussion Our case report provides direct evidence supporting the pathogenetic role of excess catecholamine secretion in the development of the takotsubo syndrome. A review of the literature reveals that both exogenous catecholamine administration (adrenaline injection in the context of anaphylaxis or infiltrative anaesthesia) and excess endogenous catecholamine (phaechromocytoma) secretion has been associated with the takotsubo syndrome. Local infiltrative anaesthesia with the addition of adrenaline is commonly used as a vasoconstrictor in a wide variety of surgical procedures. To reduce the risk of adverse events, the lowest effective concentration of adrenaline to provide pain control and vasoconstriction is recommended.

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Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report

Spina

Song

Kathir

et al. 2018

European Heart Journal - Case Reports

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“…Several case reports exist on TC caused by systemic administration of epinephrine,11––16 whereas only a single case report describes TC after nasal application of epinephrine 17. To our knowledge, only two case reports have described TC caused by cocaine abuse 18 19.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine

et al. 2014

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A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. The patient turned pale and clammy but denied chest pain at any time. An ECG showed inferolateral ST-segment elevation, and troponin T was elevated at 0.773 ng/mL. An acute coronary angiography demonstrated normal coronary arteries; however, left ventriculography showed apical ballooning of the left ventricle, and the diagnosis of takotsubo cardiomyopathy was made. This was confirmed by a subsequent transthoracic echocardiography. Four days later the patient had complete resolution of the symptoms, and a new echocardiography showed normalisation of the left ventricular systolic function with no signs of apical ballooning.

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“…Exaggerated sympathetic stimulation is probably central to the cause of this syndrome. Intravenous catecholamines can precipitate TC disorder in humans [19]. Sympathetic innervation is greatest at cardiac base and density of beta-adrenoreceptors highest at the apex of the heart.…”

Section: Reviewmentioning

confidence: 99%

A Review of Catecholamine Associated Cardiomyopathies and Channelopathies

Sethi

Peiris

2020

Cureus

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Delayed Takotsubo Cardiomyopathy Caused by Excessive Exogenous Epinephrine Administration After the Treatment of Angioedema

Cited by 13 publications

References 10 publications

Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report

Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report

Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine

A Review of Catecholamine Associated Cardiomyopathies and Channelopathies

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