Abstract
A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. LEARNING OBJECTIVE An exceptional clinical case is presented illustrating an acute myocardial infarction related to a severe allergic reaction. In addition, a review of the optimal management of this entity is carried out. We intend to make this entity known, which should be suspected in the appropriate clinical setting
Highlights
The blood analysis shows a slight elevation of Troponin T US
Precordial tightness was maintained, together with the alterations described in the ECG, and the patient was treated with intravenous nitrates without improvement for 45 minutes, for which it was necessary to administer systemic fibrinolysis with tenecteplase, the symptoms releasing and the ECG normalizing at 5 minutes (PICTURE 2)
Acute myocardial infarction (AMI) occurs as a consequence of the rupture of an atheroma plaque with the consequent adhesion of a thrombus [1], but we must know that sometimes AMI occurs for other causes, with different pathophysiological processes, that do not require antiplatelet therapy
Summary
The blood analysis shows a slight elevation of Troponin T US (peak value 250 pg / ml). The diagnosis of acute myocardial infarction was raised, probably related to a severe allergic reaction (Kounis syndrome).
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