Acute coronary thrombosis after anaphylactic shock treatment

摘要

Anaphylaxis is an acute, potentially life-threatening event. The treatment of choice is epinephrine. In patients with coronary artery disease, the adrenergic effects of such treatment have the potential for increasing myocardial demand in the face of limited blood flow, with acute ischemic consequences. We describe a patient who, after anaphylaxis treatment, developed an acute coronary arterial thrombus, which is an uncommon complication of anaphylaxis/anaphylaxis treatment. Possible pathophys-iologic mechanisms and clinical questions that bear on this case are discussed.A 68-year-old man, a current smoker with a medical history of coronary artery bypass graft surgery, diabetes mellitus, hyper-lipidemia, cigarette smoking, and gout, presented with chest pain after epinephrine treatment of anaphylactic reaction. His regular medications included metoprolol, ramipril, atorvastatin, sitagliptin, glipizide, metformin, and aspirin. The day of presentation, the patient took celecoxib and colchicine because of a left foot gout flare-up. After 40 minutes, the patient developed generalized itchiness, followed by swelling of his lips, tongue, and hands, difficulty swallowing, dyspnea, lightheadedness, and then loss of consciousness. Soon thereafter, he was treated by the paramedics, who noted an initial blood pressure of 80/60 mm Hg. He was immediately treated with diphenhydramine 50 mg intravenously, epinephrine 0.3 mg in 1:1,000 intramuscularly, and intravenous fluids.