title: Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report.
abstract: BACKGROUND
  Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.
  
  
  METHODS
  A 66-year-old man with squamous cell carcinoma of the larynx, with tumour-node-metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.
  
  
  CONCLUSIONS
  Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.
authors.affiliation: Department of Otolaryngology,Gloucestershire Royal Hospital,Gloucester,UK.
authors.forename: F
authors.initials: F
authors.lastname: Keshtkar
authors.affiliation: Department of Otolaryngology,Gloucestershire Royal Hospital,Gloucester,UK.
authors.forename: O T
authors.initials: OT
authors.lastname: Dale
authors.affiliation: Department of Otolaryngology,Gloucestershire Royal Hospital,Gloucester,UK.
authors.forename: W O
authors.initials: WO
authors.lastname: Bennett
authors.affiliation: Department of Otolaryngology,Gloucestershire Royal Hospital,Gloucester,UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Hall
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000188:drug therapy* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000150:complications; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications; D008297:Male; D009330:Nebulizers and Vaporizers; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D004837:Epinephrine
keywords: Adrenaline; Epinephrine; Airway Obstruction; Apical Ballooning Syndrome; Broken Heart Syndrome; Catecholamines; Laryngeal Neoplasm; Stress Cardiomyopathy; Takotsubo Cardiomyopathy; Takotsubo Syndrome; Transient Apical Ballooning Syndrome