Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지

Stress Induced Cardiomyopathy after Local Infiltration of Epinephrine for Plastic Surgery in Young Adult

젊은 성인에서 에피네프린 국소침윤 후 발생한 스트레스성 심근병증

  • So, Kyu Sub (Department of Plastic and Reconstructive Surgery, Fatima Hospital) ;
  • Hong, Yong Taek (Department of Plastic and Reconstructive Surgery, Fatima Hospital) ;
  • Kang, Hyun Jae (Department of Cardiology, Fatima Hospital) ;
  • Kim, Hoon Nam (Department of Plastic and Reconstructive Surgery, Fatima Hospital) ;
  • Lim, Young Kook (Department of Plastic and Reconstructive Surgery, Fatima Hospital) ;
  • Heo, Jun (Department of Plastic and Reconstructive Surgery, Fatima Hospital)
  • 소규섭 (대구파티마병원 성형외과) ;
  • 홍용택 (대구파티마병원 성형외과) ;
  • 강현재 (대구파티마병원 순환기내과) ;
  • 김훈남 (대구파티마병원 성형외과) ;
  • 임영국 (대구파티마병원 성형외과) ;
  • 허준 (대구파티마병원 성형외과)
  • Received : 2010.07.17
  • Accepted : 2010.09.16
  • Published : 2010.11.10
⟨ Previous Next ⟩

Abstract

Purpose: Epinephrine itself exhibits some cardiotoxicity. However, it rarely induces cardiomyopathy when used in standard doses during surgery for local hemostasis. This paper reports a rare case of stress-induced cardiomyopathy in a young woman after the local infiltration of epinephrine. Methods: Corrective rhinoplasty was planned in a 20-year-old woman. Lidocaine mixed with epinephrine 1:100,000 was injected around the skin of the nose and nasal septum after inducing anesthesia, which resulted in sinus tachycardia and hypotension. Postoperative ECG showed a T wave inversion in the lead V2 and echocardiography revealed transient hypokinesia in the cardiac apex. Cardiac enzyme was mildly elevated. Results: Symptoms and laboratory findings improved considerably, and the patient was discharged from hospital without complications on the sixth day after surgery. Conclusion: The prognosis of catecholamine-induced cardiomyopathy is generally favorable. However, it is important to be aware of the possible adverse effects of local epinephrine infiltration. This case highlights the need for caution when using epinephrine.

Keywords

References

  1. Kim CJ, Kim JM, Jang YH, Shin YS: Cardiomyopathy after local infiltration or application of epinephrine for plastic surgery under general anesthesia. Korean J Anesthesiol 56: 725, 2009 https://doi.org/10.4097/kjae.2009.56.6.725
  2. Cho CK, Jung SM, Kim JY, Kwon HU, Kang PS: Stress induced cardiomyopathy after local epinephrine use. Korean J Anesthesiol 54: 581, 2008 https://doi.org/10.4097/kjae.2008.54.5.581
  3. Kim JY, Choi SR, Lee SC, Chung CJ: Acute pulmonary edema due to local epinephrine injection during tonsillectomy. Korean J Anesthesiol 47: 890, 2004 https://doi.org/10.4097/kjae.2004.47.6.890
  4. Sato Y, Tanaka M, Nishikawa T: Reversible catecholamineinduced catecholamineinduced cardiomyopathy by subcutaneous injections of epinephrine solution in an anesthetized patient. Anesthesiology 92: 615, 2000 https://doi.org/10.1097/00000542-200002000-00048
  5. Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM: Catecholamine-induced cardiomyopathy. Endocr Pract 14: 1137, 2008 https://doi.org/10.4158/EP.14.9.1137
  6. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I: Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 38: 11, 2001 https://doi.org/10.1016/S0735-1097(01)01316-X
  7. Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, Kono Y, Umemura T, Nakamura S: Tako-tsubolike left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 143: 488, 2002 https://doi.org/10.1067/mhj.2002.120970
  8. Sardesai SH, Mourant AJ, Sivathandon Y, Farrow R, Gibbons DO: Pheochromocytoma and catecholamine induced cardiomyopathy presenting as heart failure. Br Heart J 63: 234, 1990 https://doi.org/10.1136/hrt.63.4.234
  9. Abdulla I, Ward MR: Tako-tsubo cardiomyopathy: how stress can mimic acute coronary artery occlusion. Med J Aust 187: 357, 2007
  10. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC: Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352: 539, 2005 https://doi.org/10.1056/NEJMoa043046
  11. BybeeKA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS: Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 94: 343, 2004 https://doi.org/10.1016/j.amjcard.2004.04.030
  12. Jiang JP, Downing SE: Catecholamine cardiomyopathy: Review and analysis of pathogenetic mechanisms. Yale J Biol Med 63: 581, 1990
  13. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS: Systemic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 141: 858, 2004 https://doi.org/10.7326/0003-4819-141-11-200412070-00010
  14. Chae JH, Cho NS, Chung CD: Cardiac arrest due to excessive Infiltration of epinephrine during operation. Korean J Anesthesiol 21: 846, 1988 https://doi.org/10.4097/kjae.1988.21.5.846
  15. Gilman AG, Goodman LS, Rull TW: The pharmacological basis of therapeutics. 7th ed, New york, Macmillan Publishing Co., 1985, p 158