Assessing the Role of High-Dose β-Agonists Use in Triggering Takotsubo Syndrome during Asthma Exacerbation

Abstract

A surge in catecholamine levels has been postulated as a potential mechanism causing cardiomyopathy, particularly Takotsubo Syndrome (TTS). Consequently, repeated exposure to β1/β2 agonists could contribute to the development of TTS in patients with asthma during periods of intense exacerbation. Even when no guidelines have been proposed for the identification and management of asthmatic patients who might develop TTS, recurrent asthma exacerbation requiring prolonged use of β1/β2 agonists have the potential of triggering life-threatening arrhythmias and increasing hospital deaths. We conducted a PubMed search for published case reports, experimental studies, animal studies, and review articles examining TTS documentation among patients with asthma. We encountered 45 articles, of which 21 were case reports that were reviewed separately for age, sex, diagnosis, recurrence, electrocardiogram findings, echo results, and mortality. Based on our review, it appears as if the use of high doses of β-agonists may predispose patients with asthma to cardiac events that might be preventable if physicians are aware of this association and become more judicious in their use of β-agonists. A standardized identification and treatment protocol would certainly be most helpful.