A Rash Decision. The Hazards of the Wrongful Use of Adrenaline

• Main Author: Coutinho Cruz, M
• Publication Date: 2017
• Other Authors: Sá Carvalho, R, Modas Daniel, P, Cruz Ferreira, R
• Format: Article
• Language: eng
• Source: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Download full: http://hdl.handle.net/10400.17/2939
• topic: HSM CAR; ACEI-Induced Angioedema; Acute Myocardial Infarction; Adrenaline; Anaphylaxis

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.