Repeated use of albuterol inhaler as a potential cause of Takotsubo cardiomyopathy

Abstract

Patient: Female, 78Final Diagnosis: Takotsubo cardiomyopathySymptoms: Chest discomfort, chest pain, dyspnea, short of breathMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual or unexpected effect of treatmentBackground:Takotsubo cardiomyopathy is an increasingly recognized cardiac condition that usually results from an acute stressor. Some medications are becoming recognized as possible stressors. Albuterol is widely used in general medicine. We report an unusual link between Takotsubo cardiomyopathy and albuterol.Case Report:A 78-year-old woman presented to our emergency department for chest pain of 2-day duration. The patient had been taking albuterol inhaler therapy for worsening shortness of breath followed by chest pain. Her albuterol use was excessive. There were no other acute stressors. The electrocardiogram showed ST-elevations in the anterior and inferior leads. Emergent coronary angiography showed noncritical coronary artery disease and left ventriculography showed apical ballooning.Conclusions:When patients taking albuterol present with acute chest pain in the absence of other etiologies, beta-agonist-induced Takotsubo cardiomyopathy should be considered.

International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology

“… 177 Exogenous drugs in terms of catecholamines 56 , 178 and sympathomimetic drugs 56 , 179 may also act as triggers for TTS including dobutamine stress testing, 180 electrophysiological testing 181 (with isoproterenol or epinephrine) and beta-agonists for asthma or chronic obstructive lung disease. 179 , 182 Also, acute coronary artery obstruction might act also as a trigger for TTS. 47…”

Reversible Cardiomyopathies

“…Additionally, there have been numerous reports linking this entity to certain medications and toxins such as albuterol, 69 high-dose intravenous cytarabin, 70 5-fluorouracil, 71 entacapone, 72 and allopurinol 73 as well as the inhalation of hypochlorite gel exhalations. 74 Furthermore, a case has been reported on a possible link to cocaine abuse.…”

Effectiveness of Levosimendan in an 84-Year-Old Patient with Takotsubo Syndrome Complicated by Acute Heart Failure

“…Patients with chronic obstructive pulmonary disease (COPD) are particularly susceptible to TTS. The most common stress factor is exacerbation of asthma or COPD, but TTS can also be caused by the constant use of β 2 -mimetic drugs [ 3 , 4 ].…”