Reverse Takotsubo Cardiomyopathy, Flash Pulmonary Edema and Cardiac Arrest after Topical Nasal Phenylephrine and Mucosal Epinephrine Injection

Uzung Yoon^1, and Elia Elia¹

¹Department of Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, 19107, PA, USA

Cite this paper

Uzung Yoon and Elia Elia. Reverse Takotsubo Cardiomyopathy, Flash Pulmonary Edema and Cardiac Arrest after Topical Nasal Phenylephrine and Mucosal Epinephrine Injection. American Journal of Medical Case Reports. 2017; 5(12):293-297. doi: 10.12691/AJMCR-5-12-3

Abstract

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is characterized by acute reversible apical ventricular dysfunction and apical akinesis in the absence of obstructive coronary artery disease. Reverse-takotsubo is a variant form of takotsubo cardiomyopathy with basal and midventricular dysfunction and normal apical function. It is known to be more common in young patients. We present a case of a 14-year-old patient who developed reverse-takotsubo cardiomyopathy with flash pulmonary edema after topical nasal phenylephrine and iatrogenic epinephrine containing local anesthetic injection for a dental procedure. Patient experienced cardiac arrest but was resuscitated successfully and transferred to the cardiac intensive care unit. Postoperative echocardiogrpahy showed normal coronary arteries and mild left ventricular hypertrophy with uncertain correlation for the cardiac event, and the patient was discharged home with no complications.

Keywords

reverse-takotsubo, cardiomyopathy, pulmonary edema, epinephrine, phenylephrine

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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