Takotsubo cardiomyopathy due to inhaled beta agonists

Takotsubo cardiomyopathy (TC), in our current understanding, is a disorder of catecholamine myocardial toxicity. Early descriptions attributed it to endogenous catecholamine excess triggered by emotional stress. Over time physical stressors, especially acute illnesses, were recognized as triggers. Exogenous catecholamines as triggers are supported by animal data and have been only occasionally reported clinically.

Here [1] [2] are two reports of TC complicating acute exacerbations of asthma and COPD, triggered by inhaled beta agonists. Arrhythmia and hypokalemia are additional complications of beta agonists. This alongside the considerable overlap between COPD and CAD highlights the importance of cardiac precautions in appropriate patients.