title: Reverse Takotsubo cardiomyopathy in the setting of anaphylaxis treated with high-dose intravenous epinephrine.
abstract: BACKGROUND
  Takotsubo cardiomyopathy is seen, though rarely, in anaphylaxis treated with epinephrine. Stress cardiomyopathy is most likely to occur in middle-aged women. The underlying etiology is believed to be related to catecholamine release in periods of intense stress. Catecholamines administered exogenously, and those secreted by neuroendocrine tumors (e.g., pheochromocytoma) or during anaphylaxis have been reported to cause apical ballooning syndrome, or takotsubo syndrome. However, reverse takotsubo stress cardiomyopathy is rarely seen or reported in anaphylaxis treated with epinephrine.
  
  
  OBJECTIVE
  To report a case illustrating that high-dose intravenous epinephrine can trigger stress cardiomyopathy, and that the risk is heightened with inappropriate dosing in the treatment of anaphylaxis.
  
  
  METHODS
  We report a rare case of iatrogenic reverse takotsubo syndrome in a young woman who was inappropriately treated with high-dose intravenous epinephrine for mild anaphylaxis.
  
  
  CONCLUSIONS
  Inappropriately high doses of intravenous epinephrine can trigger stress cardiomyopathy. Emergency physicians should be familiar with the diagnosis, grading, and appropriate treatments of anaphylaxis to avoid this unnecessary complication.
authors.affiliation: Department of Cardiology, Staten Island University Hospital, Staten Island, New York 10305, USA.
authors.forename: Georges
authors.initials: G
authors.lastname: Khoueiry
authors.forename: Nidal
authors.initials: N
authors.lastname: Abi Rafeh
authors.forename: Basem
authors.initials: B
authors.lastname: Azab
authors.forename: Evelina
authors.initials: E
authors.lastname: Markman
authors.forename: Alain
authors.initials: A
authors.lastname: Waked
authors.forename: Georges
authors.initials: G
authors.lastname: AbouRjaili
authors.forename: Masood
authors.initials: M
authors.lastname: Shariff
authors.forename: Thomas
authors.initials: T
authors.lastname: Costantino
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D061605:Administration, Intravenous; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000316:Adrenergic alpha-Agonists; D004837:Epinephrine