American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2017, 5(12), 293-297
DOI: 10.12691/ajmcr-5-12-3
Open AccessCase Report

Reverse Takotsubo Cardiomyopathy, Flash Pulmonary Edema and Cardiac Arrest after Topical Nasal Phenylephrine and Mucosal Epinephrine Injection

Uzung Yoon1, and Elia Elia1

1Department of Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, 19107, PA, USA

Pub. Date: January 15, 2018

Cite this paper:
Uzung Yoon and Elia Elia. Reverse Takotsubo Cardiomyopathy, Flash Pulmonary Edema and Cardiac Arrest after Topical Nasal Phenylephrine and Mucosal Epinephrine Injection. American Journal of Medical Case Reports. 2017; 5(12):293-297. doi: 10.12691/ajmcr-5-12-3


Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is characterized by acute reversible apical ventricular dysfunction and apical akinesis in the absence of obstructive coronary artery disease. Reverse-takotsubo is a variant form of takotsubo cardiomyopathy with basal and midventricular dysfunction and normal apical function. It is known to be more common in young patients. We present a case of a 14-year-old patient who developed reverse-takotsubo cardiomyopathy with flash pulmonary edema after topical nasal phenylephrine and iatrogenic epinephrine containing local anesthetic injection for a dental procedure. Patient experienced cardiac arrest but was resuscitated successfully and transferred to the cardiac intensive care unit. Postoperative echocardiogrpahy showed normal coronary arteries and mild left ventricular hypertrophy with uncertain correlation for the cardiac event, and the patient was discharged home with no complications.

reverse-takotsubo cardiomyopathy pulmonary edema epinephrine phenylephrine

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