Iatrogenic epinephrine-induced Takotsubo cardiomyopathy in beta-blocker poisoning: Case report

• Published in: Cor et vasa (English ed.) Vol. 61; no. 3; pp. e319 - e322
• Main Authors: Azouzi, Abdelbaki, Kraiem, Hajer, Mbarek, Hanen, Slim, Mehdi, Omri, Majdi, Boussarsar, Mohamed
• Format: Journal Article
• Language: English
• Published: Elsevier Sp. z o.o 01-07-2019
• Subjects: Apical ballooning syndrome; Case report; Catecholamine cardiotoxicity; Iatrogenic disease; Poisoning; Stress-induced cardiomyopathy; Takotsubo cardiomyopathy; TTC; BBB; SpO2; ECG; LVEF; Catecholamine cardiotoxicity; LV; HR; Takotsubo cardiomyopathy; Apical ballooning syndrome; BP; Iatrogenic disease; ACS; Case report; GCS; ICU; Poisoning; Stress-induced cardiomyopathy; bpm
• ISSN: 0010-8650; 1803-7712
• DOI: 10.1016/j.crvasa.2018.06.004

Takotsubo cardiomyopathy is a transient left ventricular dysfunction with wall-motion abnormalities which mimics myocardial infarction without acute coronary disease. Physiopathology of this entity remains unclear and different hypotheses are given. We present a case of a multifactor induced Takotsubo cardiomyopathy in a young 18-year-old man.
A previously healthy 18-year-old North African male presented to the emergency department for beta-blocker poisoning (acebutolol). Physical examination revealed signs of circulatory failure with cardiac conduction disturbances. The patient's hemodynamic status stabilized after fluid challenge and ephedrine infusion. At second day of hospitalization, the patient developed chest pain and dyspnea. Electrocardiogram showed an anterolateral ST segment elevation and troponin was elevated at 8.4 ng/ml. Transthoracic echocardiography revealed a reduced left ventricular ejection fraction (40%) and apical akinesia. An urgent coronarography revealed normal coronary arteries and ventriculography showed apical ballooning with preserved basal contraction. The diagnosis of Takotsubo cardiomyopathy was made. Supportive therapy allowed hemodynamic improvement. The outcome was favorable with complete resolution of symptoms and normalization of left ventricular function.
In conclusion, Takotsubo cardiomyopathy was probably triggered in the present case by the association of three etiologies: emotional stress, epinephrine infusion and beta-blocker poisoning. Physicians should be aware of possible iatrogenic triggers of this disease, especially the harmful effects of catecholamine on heart function and/or poisoning with cardiotoxic drugs.