Epinephrine
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Angina pectoris, myocardial ischaemia and Kounis syndrome type I: case report A 60-year-old man developed myocardial ischaemia, angina pectoris and Kounis syndrome type I during treatment with epinephrine for anaphylactic shock. The man presented to an emergency department with a 30-min onset of dyspnoea and a feeling of faintness after dinner. Following further investigations, he was diagnosed with anaphylactic shock. He received IM epinephrine 0.3mg injection and various other concomitant medications. He underwent fluid resuscitation with Ringer’s lactate solution. Thirty minutes following epinephrine administration, he writhed with sudden chest discomfort. He had no inspiratory stridor or erythema on his face, trunk or extremities. His lung and heart sounds were normal. A 12-lead ECG demonstrated ST-segment depression on leads II, III, aVF, and V3–6. A transthoracic echocardiography showed normal ventricular contraction. The man received nitroglycerin for suspected angina pectoris. Subsequently, chest discomfort resolved, and his ECG normalised. A coronary angiogram revealed normal coronary arteries. Therefore, it was suspected that coronary vasospasm was the cause of his myocardial ischaemia and it raised the possibility of Kounis syndrome type I. He was admitted and was treated with diltiazem. Three days later, he was discharged without recurrence of anaphylaxis or chest pain [not all times to reactions onsets stated]. Urushidani S, et al. A potential association between myocardial ischemia and epinephrine for anaphylaxis. American Journal of Emergency Medicine 38: e1-3, No. 6, Jun 803499927 2020. Available from: URL: http://doi.org/10.1016/j.ajem.2020.01.033
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Reactions 5 Sep 2020 No. 1820
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