Takotsubo cardiomyopathy after nasal application of epinephrine--a magnetic resonance study

Takotsubo cardiomyopathy (TTC), which is characterized by transient left ventricular impairment in absence of coronary artery disease, is usually associated with emotional or physical stress, supposing that catecholamines are involved in pathophysiology. The present article reports on two cases with characteristic features of TTC following nasal application of epinephrine during nasal surgery. Both subjects serially underwent cardiovascular magnetic resonance, which revealed myocardial vasodilatation, capillary leak and regional edema in the acute state and ruled out focal necrosis. Thus, the present cases both stress the catecholamine hypothesis in the pathogenesis of TTC and underline the potential of CMR to diagnose and monitor TTC.