Epinephrine use results in ‘stress’ cardiomyopathy

Murthy, Avinash; Henien, Shady; McPherson, Craig A.; Logue, Michael A.

doi:10.1016/j.jccase.2014.11.001

Cited by 7 publications

(6 citation statements)

References 11 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is likely that there is a significant overlap in terms of pathophysiology and presentation between NSM and Takotsubo cardiomyopathy, with each a form of stress-induced cardiomyopathy 4 . Numerous publications have described an association between catecholamine infusions and stress-induced cardiomyopathy 5,6 , which may indicate why catecholamines were ineffective in our patient. The dose of dobutamine we used was very low (less than the usual doses used in the cardiogenic shock setting, typically in the range of 3-15 μg/ kg/minute), but this was primarily due to extreme tachycardia at the time.…”

Section: Discussionmentioning

confidence: 68%

Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage

Chandler

Pernu

2018

Anaesth Intensive Care

View full text Add to dashboard Cite

We present a 62-year-old female who collapsed with a subarachnoid haemorrhage. This was complicated by profound shock secondary to neurogenic stunned myocardium. As the patient demonstrated life-threatening catecholamine-resistant shock that was unresponsive to conventional treatment measures, hyperinsulinaemic euglycaemic therapy was utilised as a rescue therapy. To our knowledge this has not previously been described in the literature. The patient proceeded to stabilise and made a good recovery.

show abstract

Section: Discussionmentioning

confidence: 68%

Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage

Chandler

Pernu

2018

Anaesth Intensive Care

View full text Add to dashboard Cite

show abstract

“…Several of these observed adverse effects have been previously reported with excess epinephrine administration. 6,7 Excess catecholamines can cause multivessel coronary and arterial vasospasm, 8 increased mean arterial pressure and ventricular afterload, impaired microcirculatory dysfunction, 9 and myocardial stunning. 10,11 Pulmonary edema and hemorrhage may result from severely increased mean arterial pressure and pulmonary backflow due to significant ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Catecholamine-induced reverse takotsubo cardiomyopathy

Bhat

Gazi

Mwansa

et al. 2019

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

Takotsubo cardiomyopathy is a syndrome characterized by transient left ventricular systolic and diastolic dysfunction, similar to an acute myocardial infarction but in the absence of significant obstructive epicardial coronary artery disease. This disease manifests predominantly in postmenopausal women in the presence of stressful triggers. We present a case of reverse takotsubo cardiomyopathy involving apical sparing, resulting from an iatrogenic overdose of epinephrine in a young man who was treated for anaphylaxis and angioedema.

show abstract

“…Complete recoveryNassif et al 6 35, FExcision of leiomyomas0.3 mgIntra- myometrialMidComplete recoveryBelliveau and De 7 30, FInfiltration into perineum with local anaesthetic following vaginal delivery1 mgSCMid, basalComplete recoveryNazir et al 8 37, FAnaphylaxis to food (tomatoes)0.3 mgIMApicalComplete recoveryKeshtar et al 9 66, FAcute airway obstruction (neck tumour)1 µg/5 mLNebulisedApicalComplete recoveryGhanim et al 10 37, FAnaphylaxis to Hymenoptera sting0.9 mgIMMid, basalCardiogenic shock requiring extra-corporeal membrane oxygenation. 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 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

View full text Add to dashboard Cite

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.

show abstract

Epinephrine use results in ‘stress’ cardiomyopathy

Cited by 7 publications

References 11 publications

Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage

Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage

Catecholamine-induced reverse takotsubo cardiomyopathy

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

Contact Info

Product

Resources

About