Acute stress cardiomyopathy following treatment of status asthmaticus

Broken heart syndrome, otherwise known as takotsubo syndrome, is stress-induced cardiomyopathy. Clinical presentation mimics acute ST segment elevation myocardial infarction, but with characteristic left ventricular apical ballooning. The mechanism is linked to overstimulation of the sympathetic system from high circulating catecholamine levels. We report a 46-year-old Caucasian female whose treatment of status asthmaticus with ketamine and epinephrine precipitated this syndrome. She required hemodynamic support with an intra-aortic balloon pump and dobutamine infusion. Myocardial function improved dramatically with supportive treatment. Iatrogenically induced takotsubo syndrome with vasoactive agents should be suspected in acute left ventricular dysfunction without coronary artery disease.