Chest
Volume 113, Issue 5, May 1998, Pages 1417-1419
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Selected Reports
Coronary Artery Spasm Complicating Anaphylaxis Secondary To Skin Disinfectant

https://doi.org/10.1378/chest.113.5.1417Get rights and content

We report a patient in whom presumed vasospasm of an angiographically normal coronary artery led to severe transmurai myocardial ischemia. To our knowledge, this is the first case in which an allergic reaction to locally applied chlorhexidine caused such a severe reaction.

Section snippets

CASE REPORT

A 53-year-old man with no history of cardiac disease was referred for curative resection of the upper lobe of the left lung because of adenocarcinoma.

Ten minutes before anesthetic induction, a test dose of cefazolin was administered. The patient subsequently received propofol, sufentanil, and atracurium. Fifteen minutes later, profound hypotension developed (BP, 45/30 mm Hg; pulse rate, 130/min) and the monitor showed diffuse ST depression. The patient was resuscitated with ephedrine, 40 mg;

DISCUSSION

Severe anaphylaxis may induce bronchospasm, profound vasodilation, and angioedema. In such cases, underlying subclinical coronary atherosclerosis can become clinically evident. Anaphylaxis may induce an acute ischemic burden due to the combination of reduced coronary perfusion pressure, tachycardia, and sometimes severe hypoxia. This combination of events may hamper an adequate cardiac response to the extreme vasodilation and even lead to a reduced cardiac output and further deterioration.

The

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