Takotsubo Cardiomyopathy Associated With the Usage of Nebulised Adrenaline for Acute Stridor: A Case Report

Abstract

A gentleman in his 70s with previously treated oropharyngeal squamous cell carcinoma presented acutely with worsening stridor. Flexible laryngoscopy on initial assessment demonstrated bilateral vocal cord palsy, and he was subsequently resuscitated with high-flow oxygen and nebulised adrenaline. On his third day of admission, antero-lateral T-wave inversions were incidentally found on a pre-operative electrocardiogram, and a transthoracic echocardiogram showed mid-apical akinesia. After a negative inpatient coronary angiogram, he was diagnosed with Takotsubo cardiomyopathy attributed to nebulised adrenaline therapy. This case report is the first to our knowledge to report an instance of this in a patient with acute airway obstruction caused by bilateral vocal cord palsy and no prior cardiac history.

Keywords: adrenaline; bilateral vocal cord paralysis; head and neck neoplasms; stridor; takotsubo cardiomyopathy (ttc).

Figure 1. CT neck with contrast in sagittal (A) and coronal (B) planes demonstrating an upper oesophageal sphincter mass lesion with oedematous changes, suspicious for underlying malignancy.

Figure 2. Scanned pre-operative ECG trace showing T-wave inversions and right bundle branch block as described.

Paper output speed: 25 mm/s. Voltage calibration: 10.0 mm/mV.

Figure 3. Snapshots from apical four-chamber transthoracic echocardiogram (TTE) at end diastole (A) and end systole (B), demonstrating good basal contraction with impaired mid-apical function.