Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure
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(2020) 20:452
CASE REPORT
Open Access
Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure Sari Naddaf1, Scott Ehrenberg1, Rony Hakim2, Muhamad Mahamid3, Yoav Turgeman1,3 and Ofir Koren1,3*
Abstract Background: Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery. Case presentation: A healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved. Conclusion: In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment. Keywords: Epinephrine, Dilated cardiomyopathy, Heart failure, FESS, Surgery
Background Dilated cardiomyopathy (DCM) is recognized by the dilation of the right, left, or both ventricles in the absence of abnormal loading conditions as hypertension and valve disease, or significant coronary artery disease [1–5]. The etiology of DCM is extremely heterogeneous sometimes classified based on known genetic mutation. Among the non-genetics cause are different etiologies, * Correspondence: [email protected] 1 Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel 3 Heart Institute, Emek Medical Center, Afula, Israel Full list of author information is available at the end of the article
including myocarditis, exposure to drugs as cocaine, certain toxins as alcohol or allergens; complication of pregnancy, systemic endocrine or autoimmune diseases, and infection as HIV [6]. One of the rarest etiologies regarding toxin and metabolic-related cause of DCM is catecholamines, and its various derivates, which has been reported mainly in case reports or short series review [7–13]. Pheochromocytoma, as a rare neuroendocrine catecholamine-producing tumor, has also been described as an etiology of reversible DCM and was found in ~ 39% of pheochromocytoma-related cardiomyopathies [14]. Paul et al. proposed that catecholamine-induced vasoco
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