Epinephrine
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Hypertensive crisis and non-ischaemic dilated cardiomyopathy: case report A 24-year old man developed hypertensive crisis and acute non-ischaemic dilated cardiomyopathy following treatment with epinephrine [indication not stated]. The man presented with chronic rhinosinusitis. He was hospitalised for an elective functional endoscopic sinus surgery (FESS) procedure under general anaesthesia with unspecified anaesthetics. During the procedure, the surgeon applied several tampons soaked in 1:1000 dilution epinephrine [dosage not stated] to his nasal mucosa. After 90 minutes, during the surgery, his BP increased to 210/130mm Hg (hypertensive crisis), followed by pulseless electrical activity (heart failure). Therefore, CPR was initiated, during which IV epinephrine was administered in consecutive doses. Following the treatment, spontaneous circulation returned. Subsequent ECG showed sinus tachycardia and a prolonged QTc interval of 486ms, inverted T waves in leads I and aVL and no signs of acute ischemic changes. A chest x-ray revealed pulmonary oedema and a borderline enlarged cardiac shadow. Therefore, he was placed on mechanical ventilation. Transthoracic echocardiogram (TTE) showed a dilated left ventricle with an increased end-diastolic dimension (124% of normal value) with a mild reduction in LV mass, a severe decrease in systolic function, apical akinesis and hyperdynamic base. At that time, the estimated systolic left ventricular ejection fraction was 30%. Blood test showed elevated cardiac troponin and CPK. A head CT scan demonstrated mild global cerebral oedema and multiple maxillary sinus fractures. He had no history of smoking, use of illegal drugs or alcohol on daily basis, and no family history of heart diseases. A diagnosis of acute dilated cardiomyopathy due to epinephrine-soaked tampons was established. The man was transferred to the cardiac ICU and started receiving treatment with unspecified ACE inhibitors, beta-blockers and diuretics. Subsequent ECG showed normal sinus rhythm, QTc interval of 420ms and normal T wave in lateral leads. No ischaemic changes were noted on ECG and no regional wall motional abnormalities were seen on TTE. After 3 days, a repeat echocardiogram showed a normal-sized left ventricle, with preserved systolic function. Eventually, he was discharged in full functional capacity. Two weeks later, an ambulatory cardiac MRI showed mildly dilated LV cavity, good global systolic function and no signs of late gadolinium enhancement or oedema. Naddaf S, et al. Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure. BMC Cardiovascular Disorders 20: 2020. Available 803514524 from: URL: http://doi.org/10.1186/s12872-020-01706-8
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Reactions 14 Nov 2020 No. 1830
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