Vinegar Causing Chemical Pneumonitis and Subsequent Broken Heart: A Rare Case of Accidental Vinegar Inhalation, Resulting in Takotsubo Cardiomyopathy

1Sanata Barbara Cottage Hospital, Santa Barbara, CA
2Sanata Barbara Cottage Hospital, Santa Barbara, CA
3Sanata Barbara Cottage Hospital, Santa Barbara, CA
4Sanata Barbara Cottage Hospital, Santa Barbara, CA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 508

Case Presentation:

A 77‐year‐old woman with a history of controlled hypertension was doing a daily sinus treatment at home when she accidentally used distilled vinegar instead of distilled water. She began the sinus rinse and immediately realized her mistake; however, she had already inhaled a small amount of the vinegar. Soon she developed severe shortness of breath and was brought to the emergency department (ED) by her family. In the ED she required 100% oxygen via a bag‐valve mask with an oxygen saturation of only 66%; she was therefore intubated for acute respiratory hypoxemic failure. An EKG obtained in the ED showed fairly diffuse ST‐segment elevation, which was most marked in the inferior and lateral leads. The patient was quickly taken to cardiac catheterization which demonstrated patent coronary arteries as well as the typical findings of Takotsubo syndrome. An echocardiogram showed an ejection fraction of 30%–35% with apical, septal, anteroseptal, anterior, inferior, posterior, and lateral wall motion hypokinesis. The patient was then transferred to the medical intensive care unit where she required aggressive diuresis and had repeated bouts of respiratory failure, necessitating intubation a total of two additional times. She developed recurrent episodes of pulmonary edema in the setting of atrial fibrillation. Medical management included the use of amiodarone, Coreg, lisinopril, and Lasix. Her condition slowly improved over the course of her weeklong admission and prior to discharge she was saturating well on room air. She was discharged with pulmonary and cardiology follow‐up. A follow‐up echocardiogram in 1 month showed normalization of her global hypokinesis and ejection fraction.

Discussion:

The etiology of Takotsubo cardiomyopathy remains uncertain, and it is likely that the cause is multifactorial. One mechanism that has been proposed is that this syndrome is the result of high levels of catecholamines and stress‐related neuropeptides. In this case, a generally healthy elderly woman developed chemical pneumonitis after vinegar inhalation; this stress likely resulted in excess release of catecholamines. There could also be a direct effect of vinegar on her cardiac function, which is unknown.

Conclusions:

Stress‐induced (Takotsubo) cardiomyopathy has been classically attributed to an intense emotional or physical stress; therefore, it has also been known as broken heart syndrome. It is thought that during such an intense state, excessive serum catecholamine levels cause apical hypokinesis and therefore diminished left ventricular systolic function. This case illustrates an interesting and largely unseen cause of Takotsubo syndrome secondary to accidental inhalation of household vinegar. Most reported cases of vinegar inhalation are related to industrial accidents and result in chemical pneumonitis. This is the first reported case of household vinegar inhalation inducing not only chemical pneumonitis, but also Takotsubo syndrome.

To cite this abstract:

Sodavarapu S, Scott A, Belkin R, Watson T. Vinegar Causing Chemical Pneumonitis and Subsequent Broken Heart: A Rare Case of Accidental Vinegar Inhalation, Resulting in Takotsubo Cardiomyopathy. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 508. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/vinegar-causing-chemical-pneumonitis-and-subsequent-broken-heart-a-rare-case-of-accidental-vinegar-inhalation-resulting-in-takotsubo-cardiomyopathy/. Accessed November 15, 2019.

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