(182) Takotsubo Cardiomyopathy: An Unanticipated Consequence of Epinephrine and Albuterol Use in ICU

Introduction: Takotsubo Cardiomyopathy (TCM) is a growing heart ailment that is typically caused by an abrupt stressor.There is growing awareness of certain drugs as potential stresses.In Intensive care units,Epinephrine is commonly used in the setting of cardiovascular compromise.Intravenous catecholamine administration, particularly epinephrine, can trigger TCM.Albuterol can also play a role in pathogenesis of TCM.

Description: This is the report of a 46-year-old female diagnosed with TCM in setting of multiple asthma exacerbations, exposed to epinephrine and albuterol.Patient was brought due to chest pain and a history of worsening shortness of breath for one day.During transport by EMS, she received epinephrine, dueonebs nebulizations.She was confused, agitated and in severe respiratory distress.On arrival, oxygen saturation of 65% to 70% on room air. She was subsequently intubated for acute respiratory failure.Initial lab values were notable for acidosis (pH 7.2),hypercarbia (CO2 59mmHg),hypoxia (89%),leukocytosis and an elevated troponin level that trended upwards from 140 to 1263.ECHO showed LV systolic function is moderately to severely decreased with normal left ventricular wall thickness.Regional wall motion abnormalities noted.Left heart catheterisation revealed apical akinesia,basal segment hyperkinesia with ballooning of the ventricles;concluded as TCM.

Discussion: Takotsubo cardiomyopathy (TCM) refers to a transient and reversible systolic left ventricular apical wall motion abnormality that resembles myocardial infarction in setting of nonexistent coronary artery disease.In TCM,there is left ventricular outflow obstruction due to underlying sudden left ventricular wall motion abnormalities that can contribute to the development of acute mitral regurgitation or shock,thus patients often present with chest pain and dyspnea and are hemodynamically unstable.Pathophysiology of TCM is relatively unknown, however the leading theory suggests a pathologic role of sudden supraphysiologic surges of catecholamines from endogenous adrenergic stimulation,in situations of extreme stress.Risk factors for TCM include excessive exposure to inhaled sympathomimetic,as adrenaline or salbutamol as seen in those with asthma,tracheal manipulation during the perioperative period, emotional and physical stress.