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Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report

Roberto Spina1, Ning Song1, Krishna Kathir1

  • 1Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia.

European Heart Journal. Case Reports
|April 26, 2019
PubMed

Insights

Excessive catecholamine secretion, particularly from exogenous adrenaline administration during local anesthesia, can trigger stress cardiomyopathy (takotsubo syndrome). This case highlights the importance of careful dosing to prevent adverse cardiac events.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pharmacology

Background:

  • Stress cardiomyopathy, or takotsubo syndrome, involves temporary left ventricular dysfunction without coronary artery disease.
  • Proposed mechanisms include vasospasm, microcirculatory issues, and catecholamine excess.

Observation:

  • A patient developed severe hypertension, tachycardia, and ECG changes post-local anesthesia for skin cancer removal.
  • Cardiac catheterization showed no obstructive coronary disease; ventriculography revealed takotsubo syndrome.
  • An unintentional 4mg subcutaneous adrenaline dose was administered with lignocaine.

Findings:

  • This case provides direct evidence linking excess catecholamine secretion to takotsubo syndrome.
  • Literature review confirms associations with exogenous (e.g., adrenaline) and endogenous (e.g., pheochromocytoma) catecholamines.
  • Adrenaline in local anesthesia is common, necessitating careful concentration management.

Implications:

  • Clinicians should use the lowest effective adrenaline concentration in local anesthesia to mitigate takotsubo syndrome risk.
  • Understanding catecholamine's role is crucial for preventing iatrogenic cardiac events.
  • This emphasizes the need for vigilance in medication administration during surgical procedures.
Abstract

Keywords:
AdrenalineCase reportEpinephrineStress cardiomyopathyTakotsubo cardiomyopathyTakotsubo syndrome

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