젊은 성인에서 에피네프린 국소침윤 후 발생한 스트레스성 심근병증 = Stress Induced Cardiomyopathy after Local Infiltration of Epinephrine for Plastic Surgery in Young Adult

다국어 초록 (Multilingual 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.
(J Korean Cleft Palate Craniofac Assoc 11: 120, 2010)

참고문헌 (Reference)

1 정찬종, "편도선 절제술 시 Epinephrine 국소침윤에 의한 급성 폐부종" 대한마취과학회 47 (47): 890-893, 2004

2 Tsuchihashi K, "Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction" 38 : 11-, 2001

3 Gilman AG, "The pharmacological basis of therapeutics. 7th ed" Macmillan Publishing Co. 158-, 1985

4 Kurisu S, "Tako-tsubolike left ventricular dysfunction with ST-segment elevation:a novel cardiac syndrome mimicking acute myocardial infarction" 143 : 488-, 2002

5 Abdulla I, "Tako-tsubo cardiomyopathy: how stress can mimic acute coronary artery occlusion" 187 : 357-, 2007

6 Bybee KA, "Systemic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction" 141 : 858-, 2004

7 Sato Y, "Reversible catecholamineinduced cardiomyopathy by subcutaneous injections of epinephrine solution in an anesthetized patient" 92 : 615-, 2000

8 Sardesai SH, "Pheochromocytoma and catecholamine induced cardiomyopathy presenting as heart failure" 63 : 234-, 1990

9 Wittstein IS, "Neurohumoral features of myocardial stunning due to sudden emotional stress" 352 : 539-, 2005

10 김찬진, "Epinephrine의 국소 침윤 및 점막 도포 후 발생한 가역적 심근증 2예" 대한마취과학회 56 (56): 725-728, 2009

11 조츈규, "Epinephrine 국소 투여 후 발생한 스트레스성 심근병증 —증례보고—" 대한마취과학회 54 (54): 581-584, 2008

12 BybeeKA, "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome" 94 : 343-, 2004

13 Kassim TA, "Catecholamine-induced cardiomyopathy" 14 : 1137-, 2008

14 Jiang JP, "Catecholamine cardiomyopathy:Review and analysis of pathogenetic mechanisms" 63 : 581-, 1990

15 Chae JH, "Cardiac arrest due to excessive Infiltration of epinephrine during operation" 21 : 846-, 1988