Myocardial Infarction Following Epinephrine Administration in Anaphylaxis: A Case Report

Abstract

Anaphylaxis is a severe, acute hypersensitivity reaction that can lead to rapid deterioration and potentially fatal outcomes if untreated. Common symptoms include shortness of breath, angioedema, and hypotension. Despite the high incidence, mortality rates remain low due to the first-line treatment, epinephrine, and its well-established effectiveness in anaphylaxis management. Epinephrine acts as an alpha- and beta-adrenergic agonist, effectively increasing blood pressure and relieving airway obstruction. However, epinephrine can rarely induce cardiovascular events. Here, we present a case of a 55-year-old male with a known history of hypertension, ischemic heart disease, and smoking. Presented to the ED with a severe allergic reaction, he was given epinephrine, which resulted in the development of myocardial infarction. The literature suggests a small but significant risk of cardiotoxicity linked to epinephrine, with intramuscular (IM) administration being preferable over intravenous (IV) due to lower associated risks. While the risk of cardiovascular events exists, timely epinephrine administration is crucial for preventing severe anaphylactic outcomes. Clinicians must be mindful of the adverse effects of epinephrine and carefully assess and monitor the patients, particularly those at risk of cardiovascular events.