PT - JOURNAL ARTICLE AU - Jens Sundbøll AU - Manan Pareek AU - Morten Høgsbro AU - Esben Hjorth Madsen TI - Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine AID - 10.1136/bcr-2013-202401 DP - 2014 Feb 19 TA - BMJ Case Reports PG - bcr2013202401 VI - 2014 4099 - http://casereports.bmj.com/content/2014/bcr-2013-202401.short 4100 - http://casereports.bmj.com/content/2014/bcr-2013-202401.full AB - A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. The patient turned pale and clammy but denied chest pain at any time. An ECG showed inferolateral ST-segment elevation, and troponin T was elevated at 0.773 ng/mL. An acute coronary angiography demonstrated normal coronary arteries; however, left ventriculography showed apical ballooning of the left ventricle, and the diagnosis of takotsubo cardiomyopathy was made. This was confirmed by a subsequent transthoracic echocardiography. Four days later the patient had complete resolution of the symptoms, and a new echocardiography showed normalisation of the left ventricular systolic function with no signs of apical ballooning.