Anaphylaxis-induced myocardial depression treated with amrinone

Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation

“…However, adrenaline resistant anaphylaxis has been recognised as an important albeit rare phenomenon probably associated with impaired cardiac function. Patients have been successfully resuscitated in this situation with large doses of adrenaline and noradrenaline, 8 amrinone, 18 glucagon, 19 and mechanical (intra-aortic balloon pump) support. 20 Our findings of pronounced ECG changes in a reaction without cardiovascular compromise or subsequent evidence of coronary disease is consistent with the increasing recognition of the human heart, which contains significant numbers of mast cells, 21 as a major shock organ in some cases of anaphylaxis.…”

Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis

“…Severe reversible cardiac dysfunction associated with non-specific electrocardiogram changes and normal coronary arteries has also been described during human anaphylaxis [8,9,10] and mast cells are present around cardiac blood vessels and between myocardial fibres in humans [11]. A number of case reports have indicated that intravenous glucagon [12], the phosphodiesterase inhibitor amrinone [13] and intra-aortic balloon pump support [9] may be useful for treating resistant anaphylactic shock when cardiac dysfunction is a problem due to beta-blockade, pre-existing impairment of left ventricular function, or cardiac anaphylaxis. We have also observed global ST segment changes in a patient without any cardiovascular instability, suggesting a direct mediator effect on the human heart [14 ].…”

Anaphylaxis: Clinical concepts and research priorities

“…It can be difficult to attribute the relative contributions of profound vasodilation and cardiac dysfunction to circulatory collapse. Therefore, it seems sensible to use vasopressors in the first instance to treat hypotension that is resistant to adrenaline and fluids, and add glucagon and/or a phosphodiesterase inhibitor if blood pressure does not improve sufficiently or if skin perfusion is poor despite an adequate blood pressure 57,58 . Urgent bedside echocardiography and invasive monitoring should be considered to guide ongoing management.…”

“…Therefore, it seems sensible to use vasopressors in the first instance to treat hypotension that is resistant to adrenaline and fluids, and add glucagon and/or a phosphodiesterase inhibitor if blood pressure does not improve sufficiently or if skin perfusion is poor despite an adequate blood pressure. 57,58 Urgent bedside echocardiography and invasive monitoring should be considered to guide ongoing management. Mechanical circulatory support (intra-aortic balloon pump) might be required.…”