Vasoespasmo inducido por adrenalina como forma de presentación de una angina variante

Caballero, Jiménez; Domínguez, J.; Bellido, C. Maicas; Cantón, Tomás; Barciela, Ramón; Moreno, Larico; Alcalá, Juan E.; Padial, Luis Rodrı́guez

doi:10.1016/s0300-8932(99)74911-0

Cited by 23 publications

(1 citation statement)

References 8 publications

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“…Most occasions of myocardial injury secondary of adrenaline were treated with nitrates with intravenous infusions or sublingual administration and calcium channel blockers [3, 6]. Our patient was treated with sublingual nitrates in the emergency unit and was not started on further treatment as he remained asymptomatic.…”

Section: Discussionmentioning

confidence: 98%

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

Jayamali¹,

Herath²,

Kulathunga³

2017

BMC Cardiovasc Disord

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BackgroundAnaphylaxis is an acute, potentially fatal medical emergency. Myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis syndrome or it can also be due to the effect of epinephrine treatment. Epinephrine is considered as the cornerstone in management of anaphylaxis. Myocardial infarction secondary to therapeutic doses of adrenaline is a rare occurrence and only a few cases have been reported in literature. The mechanism of myocardial injury was considered to be due to coronary vasospasm secondary to epinephrine as the coronary angiograms were normal on these occasions.Case presentationA 21-year- old previously healthy male got admitted to the local hospital with an urticarial rash and difficulty in breathing, one hour after ingestion of prawns for which he was known to be allergic. He was treated with 0.5 ml of intramuscular adrenaline (1:1000) which was administered to the lateral side of the thigh, following which he developed palpitations and tightening type central chest pain. Electrocardiogram showed ST segment depressions in leads III, aVF and V1 to V5 and he was transferred to a tertiary care hospital. The second electrocardiogram, done 2 h later, showed resolution of ST segment depressions but new T inversions in leads I and aVL. Troponin I was elevated with a titer of 2.15 ng/ml. He was treated with sublingual GTN in the emergency treatment unit and the symptoms resolved. Transthoracic 2D echocardiogram and stress testing with treadmill was normal and CT coronary angiogram revealed normal coronary arteries.ConclusionHere we present a case of a young healthy adult with no significant risk factors for coronary artery disease who developed myocardial infarction following intramuscular administration of therapeutic dose of adrenalin for an anaphylactic reaction. The postulated mechanism is most likely an alpha receptor mediated coronary vascular spasm. However the use of adrenaline in the setting of life threatening anaphylaxis is life saving and the benefits far outweigh the risks of adverse effects. Therefore the purpose of reporting this case is not to discourage the use of adrenaline in anaphylaxis but to make aware of this potential adverse effect which can occur in the acute setting.

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Section: Discussionmentioning

confidence: 98%

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

Jayamali¹,

Herath²,

Kulathunga³

2017

BMC Cardiovasc Disord

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Wandering coronary stenoses: Adrenaline‐induced coronary artery spasm in a patient resuscitated from cardiac arrest

Battaglia

Nammas

2010

Cathet Cardio Intervent

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A 68-year-old ex-smoker man with history of allergy, presented to the emergency department with progressive dyspnea one hour following self-medication with aspirin for troublesome headache. Examination revealed diffuse sibilant rhonchi over both lungs. Electrocardiogram showed signs of ischemia. In the intensive care unit, he received bronchodilators, nitroglycerin, and aspirin. Bronchospasm increased, and then the patient was shocked, and developed cardiac arrest. After resuscitation, he was kept on mechanical ventilation and adrenaline infusion. He was scheduled for coronary angiography. The left system demonstrated stenosis of the mid-segment of the left anterior descending artery (LAD), which was totally occluded distally, stenosis of the left circumflex (LCx) with a mild plaque in its marginal branch. The right system demonstrated stenosis of the mid-segment of the right coronary artery (RCA), with diffusely diseased posterior descending artery (PDA) and posterolateral left ventricular branch (PLLV). Successful direct stenting was performed to the RCA. Angiography demonstrated worsening of the distal stenosis in the PLLV and complete occlusion of the PDA. Balloon dilatation of the PLLV was adequate, but dilatation of the PDA failed. Repeat angiography of the left system revealed an occluded LCx with critical stenosis of its marginal branch; nevertheless, the LAD was as before. Balloon dilatation of the distal LAD was attempted without improvement, yet, angiography therein, demonstrated "migration" of the stenoses in the LCx. The procedure was halted, adrenaline infusion discontinued, and an intra-aortic balloon pump inserted. The patient was discharged one day later. Follow-up angiography 6 months later demonstrated mild atherosclerotic coronary irregularities.

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Adrenaline (Epinephrine)

2016

Meyler's Side Effects of Drugs

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Vasoespasmo inducido por adrenalina como forma de presentación de una angina variante

Cited by 23 publications

References 8 publications

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

Wandering coronary stenoses: Adrenaline‐induced coronary artery spasm in a patient resuscitated from cardiac arrest

Adrenaline (Epinephrine)

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