Double Jeopardy - Acute Myocardial Infarction complicated by Cardiogenic Shock and Contrast Mediated Anaphylactoid Reaction
Abstract
Abstract
We present the case of a 63 year-old woman who developed a severe anaphylactoid reaction to iodinated contrast in the setting of emergent percutaneous intervention (PCI) for a large anterior wall ST elevation myocardial infarction (STEMI) resulting in cardiogenic shock followed by cardiopulmonary arrest necessitating placement of the patient on the arterio-venous extra corporeal membrane oxygenation (ECMO). While anaphylactoid/anaphylactic reactions to radiocontrast agents have been well documented in literature, the development of an anaphylactoid reaction secondary to radiocontrast media in the setting of an ST elevation myocardial infarction (STEMI) and resulting in cardiogenic shock has never been reported. We go on to discuss that anaphylactoid reactions to contrast media occurs by non-immunologic (i.e. non IgE ) mechanisms. Thus why premedication does not abate or prevent all types of iodinated contrast mediated reactions. However, studies have shown that premedication is effective for a cutaneous reaction to iodinated contrast media (ICM). Due to the relative excellent safety profiles of the premedication, physicians should continue to use them prior to a suspected ICM reaction.
We present the case of a 63 year-old woman who developed a severe anaphylactoid reaction to iodinated contrast in the setting of emergent percutaneous intervention (PCI) for a large anterior wall ST elevation myocardial infarction (STEMI) resulting in cardiogenic shock followed by cardiopulmonary arrest necessitating placement of the patient on the arterio-venous extra corporeal membrane oxygenation (ECMO). While anaphylactoid/anaphylactic reactions to radiocontrast agents have been well documented in literature, the development of an anaphylactoid reaction secondary to radiocontrast media in the setting of an ST elevation myocardial infarction (STEMI) and resulting in cardiogenic shock has never been reported. We go on to discuss that anaphylactoid reactions to contrast media occurs by non-immunologic (i.e. non IgE ) mechanisms. Thus why premedication does not abate or prevent all types of iodinated contrast mediated reactions. However, studies have shown that premedication is effective for a cutaneous reaction to iodinated contrast media (ICM). Due to the relative excellent safety profiles of the premedication, physicians should continue to use them prior to a suspected ICM reaction.
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