Epinephrine

Abstract

Takotsubo Cardiomyopathy: case report A 78-year-old woman developed takotsubo cardiomyopathy (TCM) during treatment with epinephrine [indication not stated]. The woman was scheduled to undergo endoscopic sinus surgery for mycosis in the maxillary sinus. She had a history of hypertension and hyperlipidaemia. Her preoperative examinations were reported to be normal. Later, anaesthesia was induced with propofol and remifentanil. Immediately, before the incision, 3mL local anaesthesia was injected submucosally with lidocaine along with epinephrine 1:200,000 (total 0.015mg). Subsequently, her BP increased to 254/185mm Hg along with ventricular tachycardia [duration of treatment to reaction onset not stated]. Hence, the woman’s lidocaine dose was increased. Consequently, her cardiac rhythm returned to a normal; however, slight elevation in ST-segment in limb lead II was observed on ECG. She was haemodynamically stabilised. Therefore, surgery was performed. After surgery, detailed examinations revealed the following: slight cardiac dilation observed on postoperative chest X–ray, slight ST-segment elevation in the precordial lead V2 and slight depression in leads V3 to V6 observed in the 12-lead ECG, 1h after surgery. In addition to this, apical akinesias observed in an echocardiography. Therefore, on the same day coronary arteriography was performed but no significant stenosis was observed. Akinesis from the area of the apex to the left ventricle anterior wall observed in a left ventricular angiography. Her postoperative blood tests which performed 1h post-surgery revealed normal levels of creatine kinase and its isozyme-MB but troponin-I level was slightly elevated. Based on the findings, she was diagnosed for epinephrine-induced TCM. The creatine kinase and troponin-I levels reached the peak levels, after 6 hours of the surgery. Thereafter, the levels decreased gradually. She was treated with heparin as preventive therapy for intraventricular thrombosis. A 2-lead ECG showed an abnormal pattern on postoperative day 1. However, improvement of the left ventricular wall motion was observed in echocardiography. Hence, heparin was discontinued. Subsequently, on postoperative day 2, a giant negative T wave was observed in the 12-lead ECG. Eventually, it was improved after 4 months of the surgery. On postoperative day 8, decreased accumulation in the septum and increased accumulation in the base was observed which was consistent with TCM. Subsequently, her cardiac movement gradually improved, and on postoperative day 9, she was discharged from the hospital.