University Hospital Center of Poitiers, France
Posters & Accepted Abstracts: J Clin Case Rep
Introduction: Takotsubo cardiomyopathy (TTC) is an entity firstly described in 1991, characterized by acute but reversible left ventricular systolic dysfunction in the absence of atherosclerotic coronary artery disease. Acute physical or psychological stresses seem to be the most common causes of takotsubo. We reported a case of atypical TTC, during a dental procedure, including 2% xylocaine injection into gum. Case Report: A 51 year old Caucasian female underwent dental procedure. The dentist injected a solution of 2% xylocaine into the gum and three minutes following the procedure, the patient complained for chest pain, during one hour. Electrocardiogram revealed T waves inversions into inferolateral leads. Troponin level performed at admission was 23 ng per mL (N├ó┬?┬Ą0.05). Clinical examination, echocardiography and coronary angiography were normal. Cardiac magnetic resonance imaging (MRI) found a global left ventricular hypokinesis with ejection fraction of 40%, without late Gadolinium enhancement. The patient was discharged from hospital six days later, with beta blocker treatment. Left ventricular ejection fraction has been checked normal (65%) after five weeks of treatment. Conclusion: This case reports an atypical presentation of TTC, induced by xylocaine injection, during the dental procedure. This is an unexpected cardiac side effect of the xylocaine drug mechanism. Takotsubo was first described in 1991; since this is a new clinical entity, knowledge are likely to evolve in the coming years. In particular, its physiology must be better defined. Our case shows that some drugs, like local anesthetics, may be responsible of takotsubo with atypical presentation.
Matthieu Marchetti is a Physician at Emergency Department, University Hospital Center of Poitiers, France. His research interests include cardiology, heart diseases and echocardiography in emergency medicine.
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