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.
Keywords
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Article info
Publication history
Published online: July 19, 2016
Accepted:
June 5,
2016
Received in revised form:
April 7,
2016
Received:
September 23,
2015
Identification
Copyright
Crown Copyright © 2016 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
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- Intraocular Phenylephrine-Induced Takotsubo SyndromeHeart, Lung and CirculationVol. 26Issue 11
- PreviewI 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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