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Antianginal Drugs: Nitrates and β-Blockers01:16

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In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
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Epinephrine-Induced Coronary Vasospasm Exacerbating Type I Myocardial Infarction.

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JACC. Case Reports
|April 18, 2025
PubMed
Summary

Epinephrine can rarely cause heart attacks in patients with undiagnosed coronary artery disease. This case highlights the importance of cardiac monitoring during anaphylaxis treatment, especially for at-risk individuals.

Keywords:
anaphylaxiscoronary artery diseasecoronary vasospasmmyocardial infarction

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Area of Science:

  • Cardiology
  • Allergy and Immunology

Background:

  • Anaphylaxis requires prompt intramuscular epinephrine administration.
  • Epinephrine's adrenergic effects can precipitate coronary vasospasm, myocardial ischemia, and infarction, particularly in patients with pre-existing coronary artery disease (CAD).

Observation:

  • A 48-year-old male with undiagnosed CAD experienced anaphylaxis after intravenous cefepime.
  • He subsequently developed ST-segment elevation myocardial infarction (STEMI) attributed to epinephrine-induced coronary vasospasm.

Findings:

  • This case illustrates an exceedingly rare instance of type 1 STEMI following epinephrine administration for anaphylaxis in a patient with previously unrecognized CAD.
  • The underlying CAD likely exacerbated the effects of epinephrine-induced vasospasm.

Implications:

  • Vigilant cardiac monitoring is essential when administering epinephrine for anaphylactic shock.
  • Clinicians should consider underlying cardiac risk factors in patients receiving epinephrine, especially those with potential CAD.