Verdier F, Petitjeans F, Griffet V, Caignault J-R, Guerard S
Service de cardiologie, hôpital d'instruction des armées Desgenettes, Lyon, France.
Ann Cardiol Angeiol (Paris). 2011 Apr;60(2):113-7. doi: 10.1016/j.ancard.2010.12.022. Epub 2011 Jan 19.
Anaphylactic shock can sometimes take the appearance of heart failure, in relation to an acute coronary syndrome, even with normal coronary arteries, that we illustrate by two observations. We firstly report the case of an anaphylactic shock caused by succinylcholine, after anesthesia induction for inguinal hernia surgery in a 50-year-old man with cardiovascular risks, who presented with ventricular fibrillation followed by a cardiac arrest. An acute and severe anterior coronary syndrome was suspected and treated with thrombolysis. Then the electrocardiogram normalized, as well as the left ventricular function. No significant coronary stenosis was retrospectively revealed by coronarography, and a severe coronary vasospasm induced by the anaphylactic reaction was confirmed. We also describe the case of an anaphylactoid shock caused by cisatracurium infusion, that occurred at the beginning of an adnexectomy in a 55-year-old woman without any particular history. She presented with a cardiogenic shock after intravenous administration of epinephrine. The echocardiograpghic evaluation pointed out an aspect of stress-induced cardiomyopathy, and the coronarography showed normal coronary arteries. The left ventricular dysfunction completely normalized, strongly suggesting the diagnosis of Takotsubo-like syndrome after the anaphylactic shock and its treatment. Both of these cases point out the major interest of cardiologic and allergic evaluation in case of heart failure during general anesthesia. Coronary vasospasm and stress-induced cardiomyopathy are two pathologies that may be observed during anaphylactic shock, and their diagnosis should be considered after elimination of coronary thrombosis.
过敏性休克有时可能表现为心力衰竭，与急性冠状动脉综合征相关，即使冠状动脉正常，我们通过两个病例来说明。我们首先报告一例琥珀酰胆碱引起的过敏性休克病例，该病例发生在一名有心血管风险的50岁男性腹股沟疝手术麻醉诱导后，患者出现室颤继而心脏骤停。怀疑为急性重症前壁冠状动脉综合征并进行了溶栓治疗。随后心电图恢复正常，左心室功能也恢复正常。冠状动脉造影回顾性显示无明显冠状动脉狭窄，并证实为过敏性反应诱发的严重冠状动脉痉挛。我们还描述了一例由输注顺式阿曲库铵引起的类过敏性休克病例，发生在一名无特殊病史的55岁女性附件切除术开始时。静脉注射肾上腺素后，她出现了心源性休克。超声心动图评估显示有应激性心肌病的表现冠状动脉造影显示冠状动脉正常。左心室功能障碍完全恢复正常，强烈提示过敏性休克及其治疗后Takotsubo样综合征的诊断。这两个病例都指出了在全身麻醉期间发生心力衰竭时进行心脏和过敏评估的重要意义。冠状动脉痉挛和应激性心肌病是过敏性休克期间可能观察到的两种病症，在排除冠状动脉血栓形成后应考虑对其进行诊断。
