title: [Case of bronchial asthma complicated with Takotsubo cardiomyopathy after frequent epinephrine medication].
abstract: A 62-year-old man with non-topic severe persistent asthma and chronic obstructive disease suffered severe asthma exacerbation. Epinephrine was repeatedly injected subcutaneously (0.3mg x 8 times in four hours) in addition to intravenous methylprednisolone for his severe asthma. Despite these treatments, his symptoms steadily deteriorated and thus he was transferred to our hospital. He did not have chest pain or a sensation of compression, while ECG on admission demonstrated ST elevation, loss of R-wave progression, negative T waves and QT interval prolongation, suggesting ischemic heart disease. Nonetheless creatine kinase and its MB isozyme were within normal range and myosin light chain I and troponin T were only mildly elevated. Echocardiography demonstrated apical dyskinesia and hypersystole in the basal region of the heart. Finally this case was diagnosed as Takotsubo cardiomyopathy, probably due to catecholamine-mediated myocardial stunning by overuse of epinephrine for acute severe asthma exacerbation. Abnormal findings of ECG and echocardiography became normal without any specific treatments for the heart.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Saeki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Matsuse
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nakata
authors.forename: Susumu
authors.initials: S
authors.lastname: Fukahori
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Miyahara
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis; D004562:Electrocardiography; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000139:chemically induced* / Q000175:diagnosis; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000188:drug therapy*; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D004837:Epinephrine