(234) Reversible Cardiomyopathy Induced by Vasopressors

Introduction: Reversible cardiomyopathies can arise from various etiologies including tachycardia, inflammation, hyperthyroidism, and Takotsubo. Fortunately, they are known to improve when the underlying etiology is addressed. Of these Takotsubo Cardiomyopathy is believed to occur secondary to sympathoexcitation and is characterized by apical hypokinesis and reduced ejection fraction (EF) that occurs in the setting of an emotional or physically stressful event. Although pathophysiology remains uncertain, common theories include catecholamine surge causing direct toxicity, adrenoceptor-mediated damage to the myocardium, increased LV load, or coronary spasm. There are reports in the literature of exogenous catecholamines inducing paradoxical negative ionotropic effects. Presented here is a case series of reversible cardiomyopathy characterized by LV dyskinesis & EF reduction after administration of vasopressors and subsequent EF recovery after withdrawal of vasopressor treatment.

Description: Patient 1: 62-Year-Old Male, Septic Shock
Vasopressor: Phenylephrine
Echo

Results: EF changes from 75% to 45%, later 65%

Patient 2: 66-Year-Old Male, Acute Blood Loss Anemia
Vasopressor: Phenylephrine, Vasopressin, Norepinephrine
Echo

Results: EF changes from 55% to 40%, later 45%

Patient 3: 76-Year-Old Female, Septic Shock
Vasopressor: Norepinephrine
Echo

Results: EF decreased from 60% to 25%, later 35%

Patient 4: 90-Year-Old Male, s/p TAVR (Transcatheter Aortic Valve Replacement)
Vasopressor: Phenylephrine, Norepinephrine
Echo

Results: EF changes from 55% to 40%, later 45%

Patient 5: 74-Year-Old Female, Acute Blood Loss Anemia
Vasopressor: Phenylephrine
Echo

Results: EF changes from >55% to 35%, later 55%

Discussion: In the five cases identified, phenylephrine was the most common vasopressor that reduced EF by an average of 15%. Patients saw EF recover by an average of 12% in follow-up studies. Also of note, four of five of the patients identified in this study were male whereas TCM typically occurs in females. There appears to exist an association between vasopressor use and the propagation of reversible cardiomyopathy. Phenylephrine being the most common vasopressor might support coronary vasospasm etiology for the pathophysiology of the disease.