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Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report

Published online by Cambridge University Press:  05 July 2016

F Keshtkar ,
O T Dale ,
W O Bennett  and
C E Hall
F Keshtkar*
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
O T Dale
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
W O Bennett
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
C E Hall
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
*
Address for correspondence: Dr F Keshtkar, Department of Otolaryngology, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK E-mail: [email protected]
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Abstract

Background:

Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.

Case report:

A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.

Conclusion:

Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.

Keywords

Takotsubo CardiomyopathyTakotsubo SyndromeStress CardiomyopathyBroken Heart SyndromeTransient Apical Ballooning SyndromeApical Ballooning SyndromeLaryngeal NeoplasmAdrenaline; EpinephrineCatecholaminesAirway Obstruction
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 9 , September 2016 , pp. 883 - 886
Copyright
Copyright © JLO (1984) Limited 2016 

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