Acute coronary thrombosis after anaphylactic shock treatment

Lin, Robert Y.; Guillen, Paola Palomino

doi:10.1016/j.anai.2012.02.010

Cited by 1 publication

(3 citation statements)

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“…Thirteen of the 14 total patients described in these reports had an elevated troponin and 11 had new ST‐elevation or depression 10–21 . Other side effects described included decreased ejection fraction, diagnosis of cardiomyopathy, and coronary artery thrombus that was diagnosed on cardiac catheterization 19–22 . The other case reports described 34 patients in total who received an intravenous bolus dose of epinephrine inadvertently, or an inappropriately high IM dose 23–52 .…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17][18][19][20][21] Other side effects described included decreased ejection fraction, diagnosis of cardiomyopathy, and coronary artery thrombus that was diagnosed on cardiac catheterization. [19][20][21][22] The other case reports described 34 patients in total who received an intravenous bolus dose of epinephrine inadvertently, or an inappropriately high IM dose. This led to a wide array of side effects including arrhythmias, cardiomyopathy, thrombus, and cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…Of these case reports, only 13 described cardiotoxicity following administration of epinephrine using a correct dose, concentration and route. Thirteen of the 14 total patients described in these reports had an elevated troponin and 11 had new ST‐elevation or depression 10–21 . Other side effects described included decreased ejection fraction, diagnosis of cardiomyopathy, and coronary artery thrombus that was diagnosed on cardiac catheterization 19–22 .…”

Section: Discussionmentioning

confidence: 99%

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Frequency of cardiotoxicity following intramuscular administration of epinephrine in emergency department patients with anaphylaxis

Pauw,

Stubblefield,

Wrenn

et al. 2024

JACEP Open

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ObjectivesEpinephrine can be a life‐saving treatment for patients with anaphylaxis. Potential cardiovascular side effects of epinephrine may contribute to clinician hesitancy to use it. However, the frequency of cardiotoxicity resulting from epinephrine treatment for anaphylaxis is not well described. We sought to describe the frequency of cardiotoxicity following intramuscular (IM) administration of epinephrine in adult emergency department (ED) patients with anaphylaxis.MethodsWe conducted a retrospective observational study at a single, quaternary care academic ED in Tennessee. We identified consecutive ED visits with the diagnosis of anaphylaxis from 2017 to 2021 who received at least one intramuscular (IM) dose of epinephrine in the ED. Analysis was primarily descriptive. The primary outcome was cardiotoxicity, the occurrence of any of the following after epinephrine administration: ischemic electrocardiogram changes, systolic blood pressure >200 mmHg, or cardiac arrest ≤4 h; elevated troponin ≤12 h; or percutaneous coronary intervention or depressed ejection fraction ≤72 h.ResultsAmong 338 included patients, 16 (4.7%; 95%CI: 2.8–7.6%) experienced cardiotoxicity. Cardiotoxic events included eight (2.4%) ischemic electrocardiogram changes, six (1.8%) episodes of elevated troponin, five (1.5%) atrial arrhythmias, one (0.3%) ventricular arrythmia, and one (0.3%) depressed ejection fraction. Patients with cardiotoxicity were significantly older, had more comorbidities, and were more likely to have received multiple doses of epinephrine or an epinephrine infusion compared with a single IM dose of epinephrine.ConclusionsAmong 338 consecutive adult ED patients who received IM epinephrine for anaphylaxis during a recent 4‐year period, cardiotoxic side effects were observed in approximately 5% of patients.

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Section: Discussionmentioning

confidence: 99%