Takotsubo Cardiomyopathy Associated with the Administration of Intranasal Phenylephrine/Lignocaine for Epistaxis

Takotsubo cardiomyopathy (TTC) was first described in 1990 in a Japanese text1 as a reversible form of left ventricular dysfunction, followed up by a case series in five patients. Although previously considered rare, over the past two decades there has been a marked rise in the number of publications relating to TTC, with the current estimation being that the condition accounts for over 1% of all cases of acute coronary syndrome presentations. The condition is defined by transient, reversible left ventricular systolic dysfunction with no macrovascular coronary artery disease, as confirmed by coronary angiography. Epidemiologically, postmenopausal women seem to be at highest risk, however the condition has been seen in multiple different patient populations. Although classically described in the setting of acute emotional or physical stress and associated with catecholamine overstimulation, exogenous administration of sympathomimetic agents has been reported to cause stress induced left ventricular dysfunction, particularly when administered intravenously.