Systemic anaphylaxis—separation of cardiac reactions from respiratory and peripheral vascular events

Abstract

An anaphylactic reaction in the isolated perfused heart is characterized by a drastic coronary constriction, arrhythmias, and an impairment of contractility. In vivo anaphylaxis is associated with respiratory distress and cardiovascular failure. The present investigation was designed to ascertain the electrocardiographic and cardiovascular changes during systemic hypersensitivity reactions. In addition, an attempt was made to differentiate cardiac from respiratory events. In guinea pigs, sensitization was produced by s.c. administration of ovalbumin together with Freund's adjuvant solution. Fourteen days after sensitization, the effects of an i.v. infusion of ovalbumin were tested in the anesthetized guinea pigs, which were ventilated with room air or 100% oxygen. A second administration of the antigen induced the development of cardiovascular collapse, leading to death within 12 min. Within 3 min, cardiac output decreased by 90% and end-diastolic left ventricular pressure increased significantly, indicating left ventricular pump failure. In the same time range, ECG recordings uniformly showed signs of acute myocardial ischemia. In addition, arrhythmias occurred in the form of atrioventricular block. Left ventricular contractility declined continuously within the first 4 min. Finally, after 4 min, blood pressure steadily decreased. During ventilation with room air, severe hypoxia developed, with arterial PO2 decreasing from 94 mmHg to 14 mmHg after 3 min. However, under ventilation with 100% oxygen, a dissociation between cardiac damage and respiratory distress occurred. Myocardial ischemia and signs of cardiac failure preceded the development of hypoxia by a significant time interval. It is to be concluded that cardiac damage is a primary event in anaphylactic shock. Furthermore, the electrocardiographic signs of ischemia are interpreted as a result of coronary artery spasm.

Demographic and Clinical Characteristics of Patients with Anaphylactic Shock after Surgery for Cystic Echinococcosis

“…Felix and others 11 found that cardiac failure occurred earlier than respiratory failure in type I hypersensitivity under therapy of pure oxygen. They reported that cardiac muscle injury and left ventricular pump failure occurred earlier than hypoxemia.…”

Sphingosine kinase 1 and sphingosine-1-phosphate receptor 2 are vital to recovery from anaphylactic shock in mice

“…Anaphylaxis is a serious allergic reaction that typically involves the activation of mast cells and basophils (1)(2)(3). Unlike other allergic reactions involving mast cells, anaphylaxis affects the function of multiple organ systems, including the respiratory and circulatory systems, and thus it is a severe and life-threatening episode, although rarely lethal.…”

Kounis syndrome: A primary cause for the anaphylactic shock

“…The increase in left ventricular end diastolic pressure suggests that volume loss due to an increase in vascular permeability and decreased venous return are unlikely to be primary causes of the documented depression in cardiac output. The authors of this experiment definitely excluded peripheral vasodilatation as a cause of the registered anaphylactic cardiac damage [5]. Similarly, in a recent study [6], it was found that anaphylactic shock decreases cerebral blood flow more than what would be expected from severe arterial hypotension.…”