CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
e6
AFRICA
with unstable angina.
17
In this study, the mean C-reactive protein levels decreased
with methyl prednisolone but the primary endpoint did not
improve and the coronary revascularisation rates were equal.
Takotsubo-like cardiomyopathy, which results from emotional
or physical stress, is also another possible mechanism. However,
ST-segment changes similar to this phenomenon, negative T and
U waves and prolonged QT interval did not occur in our patient,
and improvement was very fast.
It can be proposed that the MI in this case was caused by
coronary spasm not anaphylactic reaction because the patient
experienced the chest pain seven minutes after the prednisolone
administration had ended. Additionally, an antihistaminic agent
had already been given. During the allergic condition, the patient
had had no cardiac discomfort for the first 10 minutes before
admision.
Rarely, fast parenteral administration of corticosteroids
for anaphylactic reactions may cause cardiovascular collapse,
especially in patients with a history of drug allergy. Some authors
postulate that acute episodes could be induced by corticosteroids,
which increased the production of epinephrine and augmented
the sensitivity of cardiomyocytes for catecholamines.
18
However,
in our case, the administration was longer than three minutes and
the drug was diluted with saline.
Furthermore, the effect of prednisolone would not have been
evident within seven minutes. So the reason for the coronary
spasm was anaphylactic reaction, and the prednisolone could
have treated the coronary spasm in the subsequent minutes.
Conclusion
Acute STEMI is a rare but clinically important complication of a
wasp sting, anaphylaxis or corticosteroid used for its treatment,
even in young adults with normal coronary arteries. Physicians
should be aware of such serious complications in order to
diagnose them early and treat properly. Therefore corticosteroid
use should always be carefully considered and the patient should
be monitored throughout.
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