Atypical (Inverted) Stress Cardiomyopathy due to Epinephrine Injection

ABSTRACT

Stress cardiomyopathy or Takotsubo cardiomyopathy can mimic acute myocardial infarction and recognition of this disease by emergency physician is important. Cardiomyopathy can be represented as variant type - classic, inverted or reverse, mid ventricular, localized. The left ventricular dysfunction that occurs with stress cardiomyopathy is believed to be secondary to a catecholamine surge brought on by intense psychological or physical stress. Regional differences in adrenergic sensitivity or innervation could explain the different variations in wall motion abnormalities. We report here on a case of inverted type stress cardiomyopathy due to iatrogenic epinephrine injection. We hope to raise awareness of the possible harmful effects of epinephrine on the myocardium even in younger patients. Thus, clinicians should be prepared to suspect, recognize, and manage this disease in patients with acute coronary syndrome like symptoms and be aware of possible iatrogenic triggers.