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Case Reports
. 2017 Oct;24(2):163-166.
doi: 10.21454/rjaic.7518.242.crz.

A rash decision. The hazards of the wrongful use of adrenaline

Madalena Coutinho Cruz  1 , Ramiro Sá Carvalho  1 , Pedro Modas Daniel  1 , Rui Cruz Ferreira  1
Affiliations
Case Reports

A rash decision. The hazards of the wrongful use of adrenaline

Madalena Coutinho Cruz et al. Rom J Anaesth Intensive Care. 2017 Oct.

Abstract

Anaphylaxis is life-threatening and should be addressed urgently. Its treatment is not without side effects and an accurate diagnosis must be made to prevent potential harm by the wrongful use of medication. A 46-year-old woman with hypertension treated with angiotensin converting enzyme inhibitor (ACEI) presented to the emergency department with non-pitting oedema of the face and limbs. A hasty diagnosis of anaphylaxis was made and intravenous adrenaline administered. The patient developed a myocardial infarction caused by coronary artery spasm that required invasive intervention. The initial clinical picture was resolved when the ACEI was discontinued unmasking a case of ACEI-induced angioedema. The correct differentiation of these two apparently similar clinical entities is of utmost importance in the management of emergency department patients.

Keywords: ACEI-induced angioedema; acute myocardial infarction; adrenaline; anaphylaxis.

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Conflict of interest statement

Conflict of interest Nothing to declare

Figures

Fig. 1.
Fig. 1.
First ECG showing 4 mm ST-segment elevation in leads DII, DIII, V5 and V6 with reciprocal ST-segment depression in leads V1, V2 and aVR (top), repeated after sublingual nitroglycerin with partial attenuation of the ST-segment elevation to 1.5 mm (bottom)
Fig. 2.
Fig. 2.
Coronary angiography showing an intermediate lesion in the distal right coronary artery (left) treated with stent placement (right)
See this image and copyright information in PMC

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