Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-02-03T13:45:26.035Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute myocardial infarction after administration of low-dose intravenous epinephrine for anaphylaxis

Published online by Cambridge University Press:  21 May 2015

Kyle J. Shaver ,
Christopher Adams  and
Steven J. Weiss
Kyle J. Shaver
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
Christopher Adams
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
Steven J. Weiss*
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
*
University of New Mexico, MSC 10 5560, 1 University of New Mexico, Albuquerque NM 87131-0001

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This case describes a 29-year-old woman who presented with an acute severe anaphylactic reaction to penicillin. In addition to other medications administered in the emergency department, she received 0.1 mg intravenously of 1:10 000 epinephrine, after which she immediately developed severe chest pain. Her ECG showed ST elevations consistent with an anterior myocardial infarction, and her serum troponin level was elevated. A CT angiogram showed no signs of coronary artery disease or abnormal anatomy. This case is an example of vasospasm-induced myocardial injury and illustrates a potential danger of intravenous epinephrine use. The authors were able to identify only 2 other case reports where therapeutic doses of epinephrine have been reported to cause this phenomenon.

Keywords

variant anginaintravenous epinephrineadverse drug effects
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 4 , July 2006 , pp. 289 - 294
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Salamone, JA. Anaphylaxis and acute allergic reactions. In: Tintinalli JE. Emergency medicine: a comprehensive study guide. 4th ed. New York: McGraw Hill; 1996. p. 209–11.Google Scholar
2.Krauss, R. Anaphylaxis [Internet]. 2005 Apr; Available: http://www.emedicine.com/EMERG/topic25.htm (accessed 2005 Dec 12).Google Scholar
3.Yasue, H, Kugiyama, K. Coronary spasm: clinical features and pathogenesis. Intern Med 1997;36:760–5.CrossRefGoogle ScholarPubMed
4.Vandergoten, P, Benit, E, Dendale, P. Prinzmetal’s variant angina: three case reports and a review of the literature. Acta Cardiol 1999;54:71–6.Google Scholar
5.Mohlenkamp, S, Eggebrecht, H, Ebralidze, T, et al. [Normal coronary angiography with myocardial bridging: a variant possibly relevant for ischemia.] Herz 2005;30:37–47.Google ScholarPubMed
6.Karch, SB. Coronary artery spasm induced by intravenous epi-nephrine overdose. Am J Emerg Med 1989;7:485–8.CrossRefGoogle ScholarPubMed
7.O-uchi, J, Komukai, K, Tohyama, J, et al. Coronary artery spasm discovered in thorough examination of perioperative VT in a 26-year-old Japanese male. Jpn Heart J 2003;44(6):1021–6.Google Scholar
8. Ferry, DR, Henry, RL, Kern, MJ. Epinephrine-induced myocar-dial infarction in a patient with angiographically normal coronary arteries. Am Heart J 1986;111:1193–5.CrossRefGoogle Scholar
9.Rubio Caballero, JA, Oteo Dominguez, JF, Maicas Bellido, C, et al. [An adrenaline-induced vasospasm as the form of presentation of variant angina.] Rev Esp Cardiol 1999;52:273–6.CrossRefGoogle ScholarPubMed
10.Saff, R, Nahhas, A, Fink, JN. Myocardial infarction induced by coronary vasospasm after self-administration of epinephrine. Ann Allergy 1993;70:396–8.Google ScholarPubMed
11.Yasue, H, Touyama, M, Kato, H, et al. Prinzmetal’s variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: documentation by coronary arteriography. Am Heart J 1976;91:148–55.CrossRefGoogle ScholarPubMed
12.van Puijenbroek, EP, Egberts, AC, Meyboom, RH, et al. Different risks for NSAID-induced anaphylaxis. Ann Pharmacother 2002;36:24–9.CrossRefGoogle ScholarPubMed
13.Takahama, H, Kubota, Y, Mizoguchi, M. A case of anaphylaxis due to ibuprofen. J Dermatol 2000;27:337–40.CrossRefGoogle ScholarPubMed
14.Brown, SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004;114:371–6.Google Scholar
15.McLean-Tooke, AP, Bethune, CA, Fay, AC, et al. Adrenaline in the treatment of anaphylaxis: What is the evidence? BMJ 2003;327:1332–5.Google Scholar
16.Davis, . Allergies and anaphylaxis: analyzing the spectrum of clinical manifestations [Internet]. 2005 Oct. Available: http://www.EMPractice.net 7(10) (accessed 2005 Dec 12).Google Scholar
17.Gu, X, Simons, FE, Simons, KJ. Epinephrine absorption after different routes of administration in an animal model. Biopharm Drug Dispos 1999;20:401–5.Google Scholar
18.Brown, SG, Blackman, KE, Stenlake, V, et al. Insect sting ana-phylaxis: prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J 2004;21:149–54.CrossRefGoogle Scholar
19.Sampson, HA, Munoz-Furlong, A, Campbell, RL, et al. Second symposium on the definition and management of anaphylaxis: summary report - Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006;117:391–7.Google Scholar
20.Karns, JL. Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report. AANA J 1999;67:419–21.Google ScholarPubMed