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Fatal angioedema associated with enalapril
P J Giannoccaro1, G J Wallace, L A Higginson
1Ottawa Heart Institute, Ottawa Civic Hospital, Ontario.
The Canadian Journal of Cardiology
|October 1, 1989
Summary
Enalapril, a heart failure medication, can cause delayed and severe angioedema, leading to respiratory arrest and death. This case highlights the potential for rebound angioedema due to the drug's long half-life.
Area of Science:
- Pharmacology
- Cardiology
- Emergency Medicine
Background:
- Angioedema is a potential adverse effect of ACE inhibitors like enalapril.
- Patients with congestive heart failure may have altered drug metabolism.
Observation:
- A 65-year-old male developed facial swelling hours after his first dose of enalapril.
- Initial treatment with diphenhydramine and hydrocortisone provided temporary relief.
- A severe relapse of angioedema occurred, leading to respiratory arrest.
Findings:
- The patient experienced profound anoxic brain damage and died five days later.
- The prolonged half-life of enalapril is suspected as the cause of the rebound angioedema phenomenon.
- This case underscores the critical need for vigilant monitoring of patients on enalapril.
Implications:
- Physicians should be aware of the potential for delayed and severe angioedema with enalapril.
- Management strategies for enalapril-induced angioedema require careful consideration of drug half-life.
- Further research into the pharmacokinetics and pharmacodynamics of enalapril in heart failure patients is warranted.