2.1 = | 1.730 Cit. to date |
842 Docs. to date |
Updated monthly
Alfredo Vieira, Bárbara Batista, Tiago Tribolet de Abreu
2018-05-02
Views: 1783
HTML: 212
PDF: 573
|
Takotsubo cardiomyopathy is a condition characterized by transient left ventricular systolic and diastolic dysfunction, with a possible direct causal role of catecholamine in its pathophysiology. We present a case of a woman with shock and adrenal insufficiency in whom Takotsubo cardiomyopathy developed after treatment with norepinephrine. This case confirms the direct causal role of catecholamine in the pathophysiology of Takotsubo cardiomyopathy. An 82-year-old woman presented with asthenia, anorexia, nausea and abdominal pain. The patient had been on chronic corticosteroid therapy until 3 months before, when she underwent abdominal surgery and corticosteroids were stopped. She now presented with acute kidney injury, hyponatremia and hyperkalemia and shock. A norepinephrine continuous infusion was administered to maintain a mean arterial pressure over 65 mmHg. An echocardiogram showed severe hypokinesis in the apical segments and hyperdynamic basal segments, with an ejection fraction of 25%. Plasma cortisol level was 4.5 µg/dL (reference range 5-25). Corticosteroid therapy was begun and norepinephrine was tapered and stopped. A new echocardiogram showed normalization of cardiac wall motion and an ejection fraction of 70%. This case highlights the importance of the correction of the cause of shock, as well as the risks associated with the use of norepinephrine if hypotension is severe or if it persists despite fluid administration, as usually recommended. It also confirms the direct causal role of catecholamine in the pathophysiology of Takotsubo cardiomyopathy. To the best of our knowledge, this is the first report of stress-induced cardiomyopathy secondary to norepinephrine by continuous infusion for shock.
2.1 = | 1.730 Cit. to date |
842 Docs. to date |
Official Journal of the
European Federation of Internal Medicine
www.efim.org
Publisher: SMC media Srl
Via Giovenale, 7 - 20136 Milan - Italy
P.IVA 07626490960
info@ejcrim.com
www.ejcrim.com - ISSN: 2284-2594 - © EFIM 2014-2023, Published by SMC Media srl, Italy - Privacy policy