Takotsubo-like left ventricular dysfuction following intravenous epinephrine administration

Abstract

A 50-year old woman presented at her general practitioner following facial swelling due to an insect bite. She was treated with 100 mg Solucortef and 1 mg epinephrine of a 1: 10 000 solution intravenously. Minutes later she developed chest pain with concomitant non-specific changes in the electrocardiogram (ECG), and later significant Troponin I concentrations were demonstrated. She was treated with anticoagulants, and later a bedside echocardiography revealed reduced left ventricular ejection fraction and apical ballooning pattern as seen in Takotsubo Cardiomyopathy. During hospitalization the patient had an episode of Torsade’s de pointes ventricular tachycardia and several unexplained cerebral absences. Coronary angiography revealed normal coronary arteries, and the patient exhibited normal ejection fraction one month after hospital discharge. Physicians should avoid giving high doses of epinephrine by the intravenous route and only in cases of severe anaphylaxis