Adrenaline bij de behandeling van anafylaxie: hard voor het hart

Abstract

Adrenaline in the treatment of anaphylaxis: hard for the heart The cornerstone of the treatment of anaphylaxis is adrenaline. The European Resuscitation Council recommends rapid administration by intramuscular route. In addition to acting as a catecholamine on alpha-1, beta-1 and beta-2 adrenergic receptors, it also reduces mediator release from mast cells, decreases obstructive respiratory symptoms and prevents cardiovascular collapse. Serious adverse effects of adrenaline when used in the treatment of anaphylaxis are rare, but can be life-threatening. This case describes a stress-induced (Takotsubo) cardiomyopathy after the erroneous administration of adrenaline via intravenous route instead of intramuscularly in a patient with anaphylaxis. Takotsubo cardiomyopathy is seen in situations of acute stress or intense emotion, mainly in middle-aged women. Clinically, this disease resembles an acute coronary syndrome with an increase in cardiac markers, changes on the electrocardiography (ECG) and reversible left ventricular dysfunction. On a coronarography, however, the coronary arteries are shown to be patent. The exact aetiology is still uncertain. The patient in this case study underwent cardiac catheterisation to rule out primary coronary artery damage and subsequently received a drug treatment with an angiotensin-converting enzyme (ACE) inhibitor and a low-dose beta blocker, in combination with a cardiac rehabilitation programme. The follow-up via a transthoracic echocardiography 1 month later showed a complete recovery of the left ventricular function.