Heart, Lung and Circulation
Clinical Spotlight| Volume 25, ISSUE 12, e159-e161, December 2016

Takotsubo Cardiomyopathy Due to Systemic Absorption of Intraocular Phenylephrine

      We present a case of Takotsubo cardiomyopathy (TTC) with regional variation in left ventricular function precipitated by intraocular injection of phenylephrine. To our knowledge, this is the first described case of TTC occurring in the setting of an intraocular medication. Contrary to the traditional model of the β2-receptor underlying the pathophysiology behind Takotsubo cardiomyopathy, phenylephrine is a pure α1-agonist implicating alternative mechanisms of myocardial injury resulting in a similar clinical phenotype. One should be alert to the possibility of catecholamine induced TTC occurring in patients subject to medications administered via the intraocular route with the potential for significant systemic absorption.


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      Linked Article

      • Intraocular Phenylephrine-Induced Takotsubo Syndrome
        Heart, Lung and CirculationVol. 26Issue 11
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          I enjoyed reading the report by Lee and Nguyen [1], published in the December 2016 issue of the Journal, about the 53-year-old woman who suffered takotsubo syndrome (TTS), initially of the classic apical variety, subsequently evolving to the mid-ventricular variant, following the intraocular injection of phenylephrine (PHE), a pure α1-adrenergic agonist, for recurrent anterior uveitis without systemic involvement, associated with acute pulmonary oedema. The patient was “commenced on intravenous dobutamine in light of her persistent hypotension and systolic dysfunction” [1], and one wonders about this drug’s role in the subsequent evolution of the apical to the mid-ventricular TTS variant.
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