Postoperative ST-segment elevation: was vasospasm caused by anaphylaxis or by its treatment with epinephrine?
Authors: Goldhaber-Fiebert, Sara; Grecu, Loreta
Source: Annals of Allergy, Asthma and Immunology, Volume 97, Number 4, October 2006 , pp. 449-453(5)
Publisher: American College of Allergy, Asthma, & Immunology
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Abstract:
Background: Anaphylaxis must be recognized and treated promptly to avoid significant morbidity and mortality. In this clinical setting, electrocardiographic changes can be multifactorial. Objective: To discuss vasospasm as a cause of myocardial ischemia and its possible triggering by anaphylaxis itself or by the administration of epinephrine. Methods: We describe a patient with multiple previous allergies who received intravenous epinephrine to treat suspected anaphylaxis. She immediately developed crushing chest pain with ST-segment elevations in the inferior leads. Throughout the discussion, we address differential diagnoses, physiologic features, and treatment. Results: Her symptoms and electrocardiographic changes were consistent with vasospasm, which resolved after treatment with sublingual nitroglycerin. However, the reaction was sufficient to cause an elevation in the troponin T level and, therefore, myocardial damage on the cellular level. Conclusions: Cardiovascular complications, including electrocardiographic changes, may be induced by anaphylactic mediators or by medications used for its treatment.Document Type: Case report
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