title: Clinical features and outcome of epinephrine-induced takotsubo syndrome: Analysis of 33 published cases.
abstract: BACKGROUND
  Takotsubo syndrome (TS) may be triggered by innumerable physical stress factors including epinephrine administration. The aim of this study is to report on the clinical features and outcome of epinephrine-induced TS (Epi-TS) in a large cohort of published cases.
  
  
  METHODS
  A computer assisted search of the electronic data base Pubmed was performed from 1990 to 2014. All cases deemed to have Epi-TS were retrieved and compared to the large recent report by Templin et al. (All-TS).
  
  
  RESULTS
  Thirty-three cases of Epi-TS were retrieved from the literature and compared to 1750 cases of All-TS. Chest pain as a presenting symptom occurred in 45% of cases. The Epi-TS patients were on average 20.6years younger than All-TS patients (p<0.0001). The women were still predominating in Epi-TS but in a significantly lower percentage compared to ALL-TS (73% in Epi-TS vs 89.8% in All-TS, p=0.0054). One third of the Epi-TS cases had basal pattern of TS compared to 2.2% of cases reported in All-TS. Epi-TS cases were characterized by high complication rates, which occurred in 57.6%. The most important risk factor for the development of TS complication was the accidental administration (P<0.001) and the dose of >1mg epinephrine (p=0.02). In spite of high complication rates, the recovery was rapid with no in-hospital mortality.
  
  
  CONCLUSIONS
  Epi-TS is characterized by a dramatic rapid onset of symptoms after epinephrine administration. Almost half of the cases had apical sparing and one third basal pattern of TS. In spite of high complication rates, the prognosis was good with no in-hospital mortality.
authors: Karolinska Institute at Karolinska University Hospital, Department of Cardiology. Electronic address: shams.younis-hassan@karolinska.se.
authors: Shams
authors: S
authors: Y-Hassan
mesh_terms: D000293:Adolescent; D000322:Adrenergic Agonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine
keywords: Broken heart syndrome; Catecholamines; Epinephrine; Takotsubo