Asthmatic Attack Complicated with Takotsubo Cardiomyopathy after Frequent Inhalation of Inhaled Corticosteroids/Long-Acting Beta2-Adrenoceptor Agonists

Abstract

A 63-year-old man was transferred to our hospital because of an exacerbation of asthma. His symptoms deteriorated even after increasing the dose of inhaled corticosteroids/long-acting beta2-adrenoceptor agonists (ICS/LABA). He had no chest pain and an electrocardiogram revealed ST elevation. A coronary angiogram revealed a reduced left ventricular function with an apical ballooning pattern without coronary stenosis. He was diagnosed with Takotsubo cardiomyopathy. Catecholamine elevation due to acute asthma and an overdose of ICS/LABA may be triggers of this disease. We should remember that Takotsubo cardiomyopathy is a complication of asthma and that catecholamine plays an important role in its onset, although it is essential for asthma treatment.

Reverse Takotsubo Cardiomyopathy in the Setting of Acute Asthma Exacerbation

“…Our patient's case of rTTC was secondary to the overuse of inhaled short-acting beta agonists as she had no other risk factors and no identifiable stressful event other than her asthma exacerbation to incite her disease process. A case similar to ours has been documented in the literature, however it was classic TTC with apical hypokinesis and was secondary to overuse of inhaled long-acting beta agonists (LABA) [8]. Additionally, there is a report of a 43-year-old female that presented in status asthmaticus that was later diagnosed with classical TTC [9].…”

Rare Association of Takotsubo Cardiomyopathy with Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness

“…Other studies have also shown stress cardiomyopathy in the setting of an acute asthma exacerbation or after repeated use of beta2-agonist inhalation [10][11][12][13][14][15][16][17]. Most of the cases involved elderly women with a history of asthma presenting with dyspnea rather than chest pain [12][13][14][15][16][17][18][19]. Only 1 case involved a male patient who presented with asthma exacerbation complicated with stress cardiomyopathy after frequent inhalation of steroids and long acting beta2-agonist [17].…”

“…Most of the cases involved elderly women with a history of asthma presenting with dyspnea rather than chest pain [12][13][14][15][16][17][18][19]. Only 1 case involved a male patient who presented with asthma exacerbation complicated with stress cardiomyopathy after frequent inhalation of steroids and long acting beta2-agonist [17]. There was resolution of the cardiomyopathy after 2 to 3 weeks among the cases reported.…”

重篤な喘息発作中に造影剤を使用せざるを得ず，吸入麻酔薬を使用して良好な経過を得た1例(A patient who could not but use contrast media during serious asthma attack, and obtained good course using inhalation anesthetic)

“…気管支喘息発作とたこつぼ型心筋症の合併についてはSaitoら 6)によると女性で重篤な発作での報告が多いとされるが，喘息発作のストレス自体だけではなく，喘息の治療に使用されるβ刺激薬，アドレナリンなどが誘因となる可能性も指摘されている 7)。本症例では，前医にて鼻内噴霧でアドレナリンが使用されており，たこつぼ型心筋症の誘因となった可能性は否定できない。しかし，同じ加療が以前も行われており，はっきりした関連性は不明である。また前医の処置内容の詳細は救急外来でははっきりわかっておらず，入院翌日の診療情報提供書にて判明した。喘息の治療としてβ刺激薬やアドレナリンを投与する前に心電図変化を認めており，喘息発作のストレスにより引き起こされた可能性が高いと考えられた。…”