Post-Anaphylaxis Adrenaline-Induced Takotsubo Cardiomyopathy: A Case Report

Takotsubo cardiomyopathy (TCM) is an acute and reversible cardiac condition triggered by an adrenaline rush in response to stress that is characterised by apical ballooning of the left ventricle in the absence of coronary artery obstruction. Although the exact pathophysiology remains unclear, it is believed to be secondary to the release of adrenaline or catecholamine in response to stress. We present the case of a 71-year-old female who presented to a district general hospital (DGH) at approximately 1700 pm in the evening with signs and symptoms of anaphylaxis following the consumption of pistachios the night before. She woke up with mild shortness of breath (sob) in the morning at 0900 am. The symptoms progressively got worse after midday, and she developed throat tightness and mild tongue swelling at 1600, prompting her to attend the local hospital's accident and emergency department. Following evaluation in the accident and emergency department, she was given 0.5 mg of adrenaline one in 1000 (1 mg/mL) solution intramuscularly for a delayed allergic reaction to pistachios. She developed central chest pain and tightness within minutes of receiving the intramuscular adrenaline, and an electrocardiogram showed ST elevation in the lateral leads and ST depression inferiorly. She was transferred to our cardiac centre for emergency coronary angiography, and bedside echocardiography revealed mild to moderate left ventricular systolic dysfunction (LVSD). Coronary angiography via the right radial access showed unobstructed coronaries. Left ventriculogram (LVG) post-angiogram demonstrated apical ballooning suggestive of TCM secondary to adrenaline administration for anaphylaxis to pistachio. Departmental echocardiography revealed a mild LVSD with an ejection fraction of 45%. She was started on bisoprolol in addition to her regular medications. Echocardiography demonstrated normal left ventricular function three months later, and the patient was discharged from the outpatient clinic.