Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine

Sundbøll, Jens; Pareek, Manan; Høgsbro, Morten; Madsen, Esben Hjorth

doi:10.1136/bcr-2013-202401

Cited by 18 publications

(9 citation statements)

References 18 publications

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“…According to Hassan et al, Ei-TCM is mainly caused by the therapeutic use of epinephrine for anaphylaxis or the inadvertent use of high-dose epinephrine [ 7 ]. In rare cases, Ei-TCM is induced by surface anesthesia of the nasal mucosa [ 8 ] and irrigation fluid for arthroscopy [ 9 ]. The typical dose of epinephrine ranges between 0.3 mg and 1 mg [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Induced by Very Low-Dose Epinephrine Contained in Local Anesthetics: A Case Report

et al. 2021

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Patient: Female, 78-year-old Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Tachycadia Medication:— Clinical Procedure: — Specialty: Anesthesiology • Cardiology Objective: Diagnostic/therapeutic accidents Background: Takotsubo cardiomyopathy is a reversible left ventricular dysfunction triggered by emotional or physical stress. Perioperatively, takotsubo cardiomyopathy is sometimes induced by various psychological factors, such as stress from surgery, and non-psychological factors, such as epinephrine misinjection. This report describes a case of takotsubo cardiomyopathy induced by the administration of very low-dose epinephrine contained in a local anesthetic. Case Report: A 78-year-old woman with mycosis in the maxillary sinus was scheduled to undergo endoscopic sinus surgery. After the submucosal injection of 3 mL of local anesthetic (lidocaine, 0.5%; epinephrine, 1: 200 000) immediately before the incision, her heart rate and blood pressure reached 135 beats per min and 254/185 mmHg, respectively, inducing ventricular tachycardia. After receiving 50 mg of lidocaine, her cardiac rhythm resumed a normal sinus rhythm, without cardioversion. As her hemodynamics stabilized, the surgical procedure began as planned. Postoperative electrocardiography, echocardiography, and coronary arteriography demonstrated takotsubo cardiomyopathy. Subsequently, her cardiac movement gradually improved, and she was discharged from the hospital on postoperative day 9. Conclusions: To the best of our knowledge, this is the first reported case in which a very small amount of epinephrine (0.015 mg) induced takotsubo cardiomyopathy. Therefore, epinephrine should be used cautiously, especially in the nasal mucosa, vaginal mucosa, and uterus, where blood flow is relatively high. If unexpected hemodynamic alterations and ST-segment abnormalities occur after epinephrine administration, asymptomatic takotsubo cardiomyopathy should be considered.

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Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Induced by Very Low-Dose Epinephrine Contained in Local Anesthetics: A Case Report

et al. 2021

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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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“…In this latter group, chemotherapy-induced takotsubo in the setting of malignancy was the most common. Unlike cases with catecholamine infusions, chemotherapy- 6 Nebulized epinephrine Acute airway obstruction 1 mg/5 mL nebulization therapy twice total Esnault et al 7 Epinephrine Iatrogenic 1 mg once subcutaneously Sundboll et al 8 Epinephrine and cocaine Biopsy of tumor Topical use with 3.2 mg of epinephrine and 320 mg of cocaine Kajander et al 9 Epinephrine Anaphylaxis Epinephrine 0.1 mg IV Khoueiry et al 10 48 Inhaled albuterol COPD NA Parsa et al 49 Inhaled albuterol Asthma 10 inhalations before admission Venditti et al 50 Salmeterol Bronchitis NA Abbreviations: COPD, chronic obstructive pulmonary disease; IM, intramuscular; IV, intravenous; NA, not applicable. induced cases of TCM appear much less uniform and convincing (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Takotsubo Cardiomyopathy

Kido

Guglin

2017

J Cardiovasc Pharmacol Ther

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Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine

Cited by 18 publications

References 18 publications

Takotsubo Cardiomyopathy Induced by Very Low-Dose Epinephrine Contained in Local Anesthetics: A Case Report

Takotsubo Cardiomyopathy Induced by Very Low-Dose Epinephrine Contained in Local Anesthetics: A Case Report

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

Drug-Induced Takotsubo Cardiomyopathy

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