Korean J Anesthesiol.  2007 May;52(5):591-595. 10.4097/kjae.2007.52.5.591.

Acute Heart Failure Induced by a beta-blocker after the Local Infiltration of Epinephrine: A case report

• Lee JY
• Kim CH
• Lee SJ
• Jun NH
• Park WK

• KMID: 2239881
• DOI: http://doi.org/10.4097/kjae.2007.52.5.591

Abstract

Topical epinephrine can cause severe hypertension, ventricular tachycardia, myocardial ischemia, cardiac arrest or pulmonary edema. The increased blood pressure and left ventricular afterload, as well as decreased left ventricular compliance caused by epinephrine may also decrease the cardiac output. If a beta blocker is used in these situations, the resulting decreased contractility and inability to increase the heart rate may further compromise the cardiopulmonary function. A 26 year-old man developed tachycardia and hypertension following the local infiltration of epinephrine 2 ml (1:10,000) around the nasal mucosa and an intramucosal injection of epinephrine 7.2 ml (1:100,000). He was treated with intravenous esmolol 10 mg. He showed a decreasing heart rate and blood pressure, depressed ST segments and inverted T waves. At the same time, the pulsation of the femoral arteries was not palpable. Cardiac massage was started. He was treated with intravenous atropine 0.5 mg and epinephrine 5microgram. He recovered from circulatory failure after this treatment and his ECG showed a normal sinus rhythm.

Keyword

electromechanical dissociation; epinephrine; esmolol

MeSH Terms

Adult
Atropine
Blood Pressure
Cardiac Output
Compliance
Electrocardiography
Epinephrine*
Femoral Artery
Heart Arrest
Heart Failure*
Heart Massage
Heart Rate
Heart*
Humans
Hypertension
Myocardial Ischemia
Nasal Mucosa
Pulmonary Edema
Shock
Tachycardia
Tachycardia, Ventricular
Atropine
Epinephrine