The allergic myocardial infarction dilemma: is it the anaphylaxis or the epinephrine?
- 5 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Thrombosis and Thrombolysis
- Vol. 52 (3), 941-948
- https://doi.org/10.1007/s11239-021-02389-4
Abstract
We highlight two distinct cases of myocardial infarction occurring concurrently with anaphylaxis at our centre in Singapore. The first case had cardiac symptoms and electrocardiogram changes concomitant with his anaphylaxis presentation, suggestive of Kounis syndrome, while the second case presented with anaphylaxis and only developed cardiac symptoms and electrocardiogram changes after treatment with intramuscular epinephrine, suggestive of epinephrine-induced myocardial infarction. Both these conditions are uncommon and under-recognised, and we review the current literature to compare the similarities and differences in their clinical manifestations, pathophysiology, and management. Kounis syndrome occurs secondary to mast cell degranulation ultimately resulting in coronary vasospasm, platelet activation and inflammatory response, whereas epinephrine causes platelet aggregation. Therefore, treatment priorities of Kounis syndrome are treatment of allergy, treatment of vasospasm, and treatment with anti-platelet therapy and revascularization if coronary plaques are present. For epinephrine-induced myocardial infarction, after epinephrine treatment is discontinued, considerations in management are re-vascularisation or pharmacotherapy. Further research will help with better understanding of both conditions and formulation of clinical management guidelines.This publication has 38 references indexed in Scilit:
- Epinephrine Treatment of AnaphylaxisCirculation: Cardiovascular Interventions, 2009
- Inotropes and VasopressorsCirculation, 2008
- Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm?International Journal of Cardiology, 2006
- Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat‐dependent exercise‐induced anaphylaxisClinical & Experimental Allergy, 2005
- Food-dependent exercise-induced anaphylaxis: influence of concurrent aspirin administration on skin testing and provocationBritish Journal of Dermatology, 2002
- Activation of haemostasis by exercise, mental stress and adrenaline: effects on platelet sensitivity to thrombin and thrombin generationClinical Science, 1999
- Coronary artery spasm induced by intravenous epinephrine overdoseThe American Journal of Emergency Medicine, 1989
- The effect of food and exercise on the skin response to compoundJournal of Allergy and Clinical Immunology, 1988
- Adrenaline infusion evokes increased thromboxane B2 production by platelets in healthy men: the effect of beta‐adrenoceptor blockadeEuropean Journal of Clinical Investigation, 1986
- Epinephrine-induced myocardial infarction in a patient with angiographically normal coronary arteriesAmerican Heart Journal, 1986