굴곡 기관지 내시경 시술 중 에피네프린 도포 후 발생한 스트레스성 심근병증 2예 = Stress Related Cardiomyopathy during Flexible Bronchoscopy

다국어 초록 (Multilingual Abstract)

Flexible bronchoscopy is a safe medical procedure, but the incidence rate of major complications is 0.08－0.3%. Here, we report 2 cases of stress induced cardiomyopathy, which developed immediately after flexible bronchoscopy. Stress related cardiomyopathy was confirmed by EKG, echocardiography, and coronary angiogram. The cardiac functions of these patients were fully recovered with conservative treatment. Although, the pathogenesis of stress related cardiomyopathy is not well understood, post-bronchoscopy tachycardia or arrhythmia is thought to be associated with hypoxemia or catecholamine excess. Because the clinical presentation is quite similar to acute myocardial infarction, discrete evaluations are required for appropriate treatment.

참고문헌 (Reference)

1 신영민, "젊은 성인 남자에서 기관지 내 Epinephrine 도포 후 발생한 심실 세동 -증례 보고-" 대한중환자의학회 26 (26): 276-280, 2011

2 Shrader DL, "The effect of fiberoptic bronchoscopy on cardiac rhythm" 73 : 821-824, 1978

3 Koulouris S, "Takotsubo cardiomyopathy: the "broken heart" syndrome" 51 : 451-457, 2010

4 Akashi YJ, "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure" 118 : 2754-2762, 2008

5 Movahed A, "Norepinephrine-induced left ventricular dysfunction in anesthetized and conscious, sedated dogs" 45 : 23-33, 1994

6 Wittstein IS, "Neurohumoral features of myocardial stunning due to sudden emotional stress" 352 : 539-548, 2005

7 Sakr L, "Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management" 80 : 38-58, 2010

8 Paur H, "High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy" 126 : 697-706, 2012

9 Lundgren R, "Hemodynamic effects of flexible fiberoptic bronchoscopy performed under topical anesthesia" 82 : 295-299, 1982

10 Mazkereth R, "Epinephrine blood concentrations after peripheral bronchial versus endotracheal administration of epinephrine in dogs" 20 : 1582-1587, 1992

11 Suratt PM, "Deaths and complications associated with fiberoptic bronchoscopy" 69 : 747-751, 1976

12 Russell WJ, "Changes in plasma catecholamine concentrations during endotracheal intubation" 53 : 837-839, 1981

13 Frustaci A, "Catecholamine-induced cardiomyopathy in multiple endocrine neoplasia. A histologic, ultrastructural, and biochemical study" 99 : 382-385, 1991

14 Davies L, "Cardiovascular consequences of fibreoptic bronchoscopy" 10 : 695-698, 1997

15 Katz AS, "Cardiac arrhythmias. Frequency during fiberoptic bronchoscopy and correlation with hypoxemia" 141 : 603-606, 1981

16 Glamore M, "Broken heart syndrome: a risk of teenage rhinoplasty" 32 : 58-60, 2012

17 British Thoracic Society Bronchoscopy Guidelines Committee, "British Thoracic Society guidelines on diagnostic flexible bronchoscopy" 56 (56): i1-i21, 2001

18 Luck JC, "Arrhythmias from fiberoptic bronchoscopy" 74 : 139-143, 1978

19 Gianni M, "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review" 27 : 1523-1529, 2006

20 Suzuki K, "An atypical case of "Takotsubo cardiomyopathy" during alcohol withdrawal: abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment" 43 : 300-305, 2004