Cor Vasa 2019, 61(3):e319-e322 | DOI: 10.1016/j.crvasa.2018.06.004

Iatrogenic epinephrine-induced Takotsubo cardiomyopathy in beta-blocker poisoning: case report

Abdelbaki Azouzi^a,b, Majdi Omri^c,b, Hajer Kraiem^c,b, Hanen Mbarek^a, Mehdi Slim^d,b, Mohamed Boussarsar^a,b

^a Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia

^b Faculty of Medicine Ibn El Jazzar of Sousse, Tunisia

^c Emergency Medical Service, SAMU 03, Sahloul University Hospital, Sousse, Tunisia

^d Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia

Background: Takotsubo cardiomyopathy is a transient left ventricular dysfunction with wall-motion abnormalities which mimics myocardial infarction without acute coronary disease. Physiopathology of this entity remains unclear and different hypotheses are given. We present a case of a multifactor induced takutsubo cardiomyopathy in a young 18-year-old man. Case presentation: A previously healthy 18-year-old North African male presented to the emergency department for beta-blocker poisoning (propranolol). Physical examination revealed signs of circulatory failure with cardiac conduction disturbances. The patient's hemodynamic status stabilized after fluid challenge and ephedrine infusion. On second day of hospitalization, the patient developed chest pain and dyspnea. Electrocardiogram showed an anterolateral ST segment elevation and troponin was elevated at 8.4 ng/ml. Transthoracic echocardiography revealed a reduced left ventricular ejection fraction (40%) and apical akinesia. An urgent coronarography revealed normal coronary arteries and ventriculography showed apical ballooning with preserved basal contraction. The diagnosis of Takotsubo cardiomyopathy was made. Sup- portive therapy allowed hemodynamic improvement. The outcome was favorable with complete resolution of symptoms and normalization of left ventricular function. Discussion and conclusions: In conclusion, Takotsubo cardiomyopathy was probably triggered in the present case by the association of three etiologies: emotional stress, epinephrine infusion and beta-blocker poison- ing. Physicians should be aware of possible iatrogenic triggers of this disease, especially the harmful effects of catecholamine on heart function and/or poisoning with cardiotoxic drugs.

Keywords: Apical ballooning syndrome, Case report, Catecholamine cardiotoxicity, Iatrogenic disease, Poisoning, Stress-induced cardiomyopathy, Takotsubo cardiomyopathy

Accepted: June 12, 2018; Published: June 21, 2019  Show citation