J Korean Cleft Palate-Craniofac Assoc.  2010 Oct;11(2):120-123.

Stress Induced Cardiomyopathy after Local Infiltration of Epinephrine for Plastic Surgery in Young Adult

• So KS
• Hong YT
• Kang HJ
• Kim HN
• Lim YK
• Heo J

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.

Keyword

Epinephrine; Catecholamine; Stress induced cardiomyopathy

MeSH Terms

Anesthesia
Cardiomyopathies
Echocardiography
Electrocardiography
Epinephrine
Female
Hemostasis
Humans
Hypokinesia
Hypotension
Lidocaine
Nasal Septum
Nose
Prognosis
Rhinoplasty
Skin
Surgery, Plastic
Tachycardia, Sinus
Young Adult
Epinephrine
Lidocaine