Takotsubo cardiomyopathy due to systemic absorption of intraocular phenylephrine

We present a case of Takotsubo cardiomyopathy (TTC) with regional variation in left ventricular function precipitated by intraocular injection of phenylephrine. To our knowledge, this is the first described case of TTC occurring in the setting of an intraocular medication. Contrary to the traditional model of the b2-receptor underlying the pathophysiology behind Takotsubo cardiomyopathy, phenylephrine is a pure a1-agonist implicating alternative mechanisms of myocardial injury resulting in a similar clinical phenotype. One should be alert to the possibility of catecholamine induced TTC occurring in patients subject to medications administered via the intraocular route with the potential for significant systemic absorption.