Key result
1 mg IV epinephrine linked to Takotsubo-like LV dysfunction and Torsades de pointes.
Case Report (n=1)
Intravenous administration of high-dose epinephrine can induce Takotsubo-like cardiomyopathy and life-threatening arrhythmias, highlighting the need to reserve this route for severe anaphylaxis.
High-dose IV epinephrine use merits caution beyond anaphylaxis; this Level 5 case leaves open confirmation in larger cohorts.
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
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Alyonan et al. (2014) conducted a case report in Takotsubo-like left ventricular dysfunction (n=1). Intravenous epinephrine was evaluated on Takotsubo-like left ventricular dysfunction. Intravenous administration of 1 mg epinephrine induced Takotsubo-like left ventricular dysfunction, Torsade's de pointes, and cerebral absences in a 50-year-old woman.
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