A Case of Prolonged Angioedema After Cardiac Surgery
| Autor: | Maurice F. Joyce, Taif Mukhdomi, Andrew Maslow |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Bradykinin
Angiotensin-Converting Enzyme Inhibitors chemistry.chemical_compound Edema medicine Humans Angioedema Cardiac Surgical Procedures Aged biology business.industry Angiotensin-converting enzyme Rash Anesthesiology and Pain Medicine Epinephrine chemistry Anesthesia biology.protein Female medicine.symptom Cardiology and Cardiovascular Medicine Airway business Complement C1 Inhibitor Protein medicine.drug Capillary Leak Syndrome |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 34:1890-1896 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2019.12.025 |
| Popis: | Angioedema (AE) is a transient capillary leak syndrome, caused by either histamine or bradykinin, that presents as an acute nonpitting swelling of the skin, subcutaneous tissues, and mucous membranes of the face, lips, tongue, upper airways, and gastrointestinal tract, with or without a rash. A lack of response to antihistamines, steroids, and epinephrine suggests a bradykinin-mediated AE. Bradykinin-AE may be inherited, acquired, or drug related. Mechanism of increased bradykinin can include decreased C1-esterase inhibitor (C1-INH) levels or activity, increased bradykinin production, or decreased bradykinin breakdown, the latter occurring during angiotensin converting enzyme inhibitor (ACEi). A 65-year-old woman had coronary artery bypass grafting, which was complicated by prolonged bradykinin-AE owing to ACEi, requiring prolonged endotracheal tube intubation. Treatment with a C1-esterase inhibitor (Berinert) on postoperative day 7 resulted in a dramatic improvement in airway edema and tongue swelling within 7 hours, and the patient was subsequently extubated. The case is unusual because of the prolonged course of AE and the benefit of late administration of C1-INH concentrate. |
| Databáze: | OpenAIRE |
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