Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure

Sari Naddaf,Scott Ehrenberg,Muhamad Mahamid,Ofir Koren,Yoav Turgeman,Rony Hakim

doi:10.1186/s12872-020-01706-8

Abstract

BackgroundEpinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery.Case presentationA healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved.ConclusionIn our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment.

Highlights

Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death
In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective function endoscopic sinus (FESS) surgery
Case description A 24-year old male with chronic rhinosinusitis was admitted for an elective Functional endoscopic sinus surgery (FESS) procedure under general anesthesia

Summary

Conclusion

We report a rare case of a transient acute non-ischemic transient dilated cardiomyopathy following exposure to sstandard diluted dose epinephrine soaked-tampons during ENT procedure. MM, OK and YT provided care to the patient and revised the manuscript. All authors have read and approved the manuscript. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate Informed consent was waived due to the use of anonymous patient’s data as well as due to the retrospective nature of the case study. Consent for publication Written consent to publish the information presented in the clinical case was obtained from the patient.

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