title: Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine.
abstract: A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. The patient turned pale and clammy but denied chest pain at any time. An ECG showed inferolateral ST-segment elevation, and troponin T was elevated at 0.773 ng/mL. An acute coronary angiography demonstrated normal coronary arteries; however, left ventriculography showed apical ballooning of the left ventricle, and the diagnosis of takotsubo cardiomyopathy was made. This was confirmed by a subsequent transthoracic echocardiography. Four days later the patient had complete resolution of the symptoms, and a new echocardiography showed normalisation of the left ventricular systolic function with no signs of apical ballooning.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Sundbøll
authors.forename: Manan
authors.initials: M
authors.lastname: Pareek
authors.forename: Morten
authors.initials: M
authors.lastname: Høgsbro
authors.forename: Esben Hjorth
authors.initials: EH
authors.lastname: Madsen
mesh_terms: D058956:Administration, Mucosal; D000368:Aged; D001706:Biopsy / Q000379:methods*; D003042:Cocaine / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D004837:Epinephrine / Q000009:adverse effects*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000473:pathology; D011859:Radiography; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D014662:Vasoconstrictor Agents; D003042:Cocaine; D004837:Epinephrine