Takotsubo Cardiomyopathy and β-Blocker Poisoning: A Case Report

Abstract

β-blocker poisoning is frequently observed because of its primary use for the treatment of cardiovascular diseases. The management of β-blocker toxicity is dependent on the cardiovascular response and the severity of presentation. The present study describes the case of a patient with combined drug intoxication, β-blocker, digoxin, benzodiazepines, acetaminophen and opiates in a suicidal attempt. A 63-year-old female was found somnolent and in a confused state at her residence following intentional poly-drug ingestion. Upon presentation, she was found to be hemodynamically unstable and was thus treated with vasopressors. The toxicological screening performed upon presentation was positive for polydrug ingestion. On day 3, the patient developed chest pain and ST-segment elevation in anterior leads, while transthoracic echocardiographic assessment disclosed a non-dilated left ventricle with moderate dysfunction and akinesia of the apex. Coronary angiogram revealed normal coronary arteries and, subsequently, the diagnosis of Takotsubo cardiomyopathy (TTC) was suspected. Supportive treatment was initiated with favorable evolution and left ventricular ejection fraction normalization. The management of hemodynamic instability with vasopressors should be judiciously administered in the treatment of β-blocker poisoning, in view of the adverse effects on cardiac functions, including stress cardiomyopathy.

Keywords: Takotsubo cardiomyopathy; benzodiazepine and digoxin poisoning; cardiotoxicity; catecholamines; emotional stress; epinephrine; β-blocker.

Figure 1

Electrocardiogram depicting sinus rhythm, ST segment elevation in V1 and V2 and mirror image in the inferior leads (DII, DIII and aVF).

Figure 2

Coronary angiogram displaying normal (A) right and (B) left coronary arteries.