Postoperative ST-segment elevation: was vasospasm caused by anaphylaxis or by its treatment with epinephrine?
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.
Goldhaber-Fiebert
Sara
S
Department of Anesthesia and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Grecu
Loreta
L
D000707:Anaphylaxis / Q000150:complications* / Q000276:immunology*; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004837:Epinephrine / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D020107:Troponin T / Q000097:blood
D020107:Troponin T; D004837:Epinephrine