Clinical Case Report
Volume 1 Issue 1 - 2017
Iatrogenic Left Ventricular Dysfunction after Exogenous Administration of Intravenous Adrenaline
Antonio L Arrebola Moreno
Department of Cardiology, Inmaculada Concepcion Hospital, Spain
*Corresponding Author: Antonio L Arrebola Moreno, Department of Cardiology, Inmaculada Concepcion Hospital, Spain.
Received: December 12, 2016; Published: January 09, 2017
We present the clinic case of a healthy 19 year-old women that suffered an anaphylactic reaction after the sting of a vermin. She was administered intravenous adrenaline and developed acute left ventricular dysfunction.
Keywords: Adrenergic myocardiopathy; Adrenaline; Ventricular dysfunction
We present the clinical case of a healthy 19 year-old woman without any relevant past clinical history that suffered the sting of a vermin (probably a wasp) while riding a bicycle. Afterwards she presented an allergic reaction with skin rash and dyspnea. She went to the nearest emergency center and was administered a single dose of subcutaneous adrenaline relieving her symptoms. A few minutes later she started a new dyspnea episode and was administered an intravenous 80mg of methylprednisolone and 250 mg of adrenaline. After the last dose, she started an intense palpitation and sensation an oppressive non-irradiated chest pain with vegetative symptoms, vomiting and sweating. She was performed and EKG (Figure 1A) were sinus tachycardia, mild ST elevation and inverted T waves in the inferior- lateral territory, mild descended ST segment in V3 and V4, and marked (1.5 mm) elevation of ST segment in I and aVL were found. 20-30 minutes later the chest pain and EKG changes disappeared (Figure 1B). The peak levels of troponin-I were 2.75. The following days she was performed an echocardiogram (Figures 2A and 2B) were a mild dilated left ventricle (54 mm) was found together with global hipokinesia and moderately decreased ejection fraction (37%). The patient remained asymptomatic in the Cardiology ward and started treatment on Bisoprolol 2.5 mg. One week later a control echocardiogram revealed an ejection fraction of 50% and she was discharged asymptomatic. Finally, another echocardiogram was performed 6 months later showing an ejection fraction of 65% and bisoprolol was removed.
Several clinical cases have been reported regarding transient apical dyskinesia (Tako-Tsubo syndrome) after the administration of intravenous catecholamine [1,2]. Moreover, some catecholaminergic myocardiopathy cases have been reported [3,4] in patients presenting pheochromocytoma. However, no global left ventricular dysfunction (without segment wall motion abnormalities) in a complete healthy heart has been reported in this context. This case support the theory of myocardial contusion as a cause of ventricular dysfunction in patients suffering pheochromocytoma, thus, the catecholamine excess would lead to calcium overload mediated by cyclic adenosine- triphosphate that would decrease the myocyte´s synthetic activity and viability [5]. Although other pathophysiological pathways cannot be ruled out, like the production of diffuse vasospasm [6]. In the majority of these cases the ventricular dysfunction have good response to beta blockers, as well as in our patient [7]
To sum up, the novelty of this clinical case is that no other global ventricular dysfunction has been reported after the administration of intravenous catecholamines in a complete healthy heart, and helps to understand the pathophysiology of other illnneses (Tako-Tsubo Syndrome, Ventricular dysfunction in pheochromocytoma…) as well as to determine the usefulness of beta blockers in such a cases, and the possible adverse effects of exogenous adrenaline in patients with previous myocardiopathy.
Figure 1A: Electrocardiograma tras la administración de adrenalina intravenosa.
Figure 1B: Electrocardiograma de control.
Figure 2: Ecocardiograma al ingreso en 2 dimensiones (A) y modo M (B). Ecocardiograma de control a los 6 meses en 2 dimensiones (A) y modo M (B)
  1. Laínez B., et al. “Iatrogenic tako-tsubo cardiomyopathy secondary to catecholamine administration”. Revista Espanola de Cardiologia 62.12 (2009): 1498-9.
  2. Litvinov IV., et al. “Iatrogenic epinephrine-induced reverse Takotsubo cardiomyopathy: direct evidence supporting the role of catecholamines in the pathophysiology of the "broken heart syndrome”. Clinical Research in Cardiology 98.7 (2009): 457-62.
  3. Di Palma G., et al. “Cardiogenic shock with basal transient left ventricular ballooning (Takotsubo-like cardiomyopathy) as first presentation of pheochromocytoma”. Journal of Cardiovascular Medicine (Hagerstown) 11.7 (2010): 507-10.
  4. Ter Bekke RM., et al. “Pheochromocytoma-induced ventricular tachycardia and reversible cardiomyopathy”. International Journal of Cardiology 147.1 (2009): 145-6.
  5. Mann DL., et al. “Adrenergic effects on the biology of the adult mammalian cardiocyte”. Circulation 85.2 (1992): 790–804.
  6. Galetta F., et al. “Cardiovascular complications in patients with pheochromocytoma: a mini-review”. Biomedicine & Pharmacotherapy 64.7 (2010): 505-9.
  7. Sutherland JA., et al. “Catecholamine-induced cardiomyopathy rapidly reversed with beta-blocker therapy”. Congestive Heart Failure 15.4 (2009): 193-5.
Citation: Antonio L Arrebola Moreno. “Iatrogenic Left Ventricular Dysfunction after Exogenous Administration of Intravenous Adrenaline”. Therapeutic Advances in Cardiology 1.1 (2017): 12-14.
Copyright: © 2017 Antonio L Arrebola Moreno. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.