Intramuscular
adrenaline is a standard treatment approach for the symptomatic patient presenting with distress and oropharyngeal
edema, requiring subsequent doses if oedema persists. This case demonstrates a delayed side-effect of stress-induced
cardiomyopathy after
adrenaline administration. A 62-year-old suffered acute oropharyngeal
angioedema secondary to
angiotensin-converting-enzyme inhibitor use. Two standard doses of intramuscular
adrenaline 2 hours apart were administered, and she was monitored for 2 days. On day three post discharge, she represented with acute hypervolaemia. Transthoracic echocardiogram showed a globally dilated, poorly functioning left ventricle. Cardiac magnetic resonance imaging described
takotsubo cardiomyopathy. One month later, left ventricular function had normalised with optimal medical treatment.
Cardiomyopathy with a temporal relationship to a
hypersensitivity reaction is thought to occur due to one of three mechanisms: Stress (
takotsubo) cardiomyopathy, allergic acute coronary (
Kounis) Syndrome, and hypersensitive
myocarditis. If a clinical presentation of
hypersensitivity is such that it requires treatment with
epinephrine, it is particularly challenging to determine the exact cause of
cardiomyopathy.