Stress-Induced Cardiomyopathy Caused by Adrenaline Injection for Anaphylaxis

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Stress-induced cardiomyopathy accounts for 1.7-2.2% of patients presenting with acute coronary syndromes (ACS). It is thought to be related to catecholamine surge during intense stress. Here, we report stress-induced cardiomyopathy following administration of exogenous catecholamine. Case Presentation: A 73-year-old woman was admitted with diverticulitis. Intravenous tazocin was prescribed. Following IV antibiotic, she developed an anaphylactic reaction. 1 mg of intramuscular adrenaline was administered. She then complained of chest pain. Electrocardiogram showed anterior and lateral ST elevation (Figure 1) followed by ventricular fibrillation. 150 joules of direct cardioversion was given and she was subsequently thrombolysed. Coronary angiography revealed normal coronaries. Left ventriculogram (Figure 2) and transthoracic echocardiogram (TTE) (Figure 3) were consistent with Takotsubo cardiomyopathy. Discussion: Stress-induced cardiomyopathy is characterised by transient LV systolic dysfunction. Its pathogenesis is thought to be related to endogenous catecholamine surge during intense emotional or physical stress and microvascular dysfunction or spasm. Exogenous catecholamines have also been implicated in the development of stress-induced cardiomyopathy. Although long-term outcome is favourable with recovery in left ventricular (LV) systolic function within one to four weeks, in-hospital complications are comparable to patients with ACS. Here, we describe a patient who was received exogenous catecholamine for treatment of anaphylaxis who subsequently developed stress-induced cardiomyopathy. She made a good recovery. Repeat TTE performed four weeks later showed normal LV function. It is likely that the combination of endogenous and exogenous catecholamines surge during anaphylaxis contributed to the development of stress-induced cardiomyopathy.