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PICTURES IN CLINICAL MEDICINE
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Life-Threatening Angioedema after Primary Percutaneous Coronary Intervention Hirono Homma, Jiro Aoki and Kengo Tanabe Key words: angioedema, ACE-I, myocardial infarction (Intern Med 54: 999-1000, 2015) (DOI: 10.2169/internalmedicine.54.4004)
Picture 2.
Picture 1.
Picture 4.
Picture 3.
A 69-year-old man was admitted due to acute myocardial infarction. After administering aspirin and clopidogrel, pri-
mary percutaneous coronary intervention (PCI) was performed and a coronary stent was successfully implanted. After PCI, imidapril hydrochloride, lovastatin, and carvedilol were additionally administered. Seven days after PCI, he presented with painless, nonpruritic tongue swelling, which had occurred after brushing his teeth. His tongue was markedly swollen and protruded from his mouth (Picture 1). Three hours later, he experienced difficulty in breathing. Fiberoptic laryngoscopy revealed oropharygeal edema that extended to the larynx (Picture 2). Nasotracheal intubation was
Division of Cardiology, Mitsui Memorial Hospital, Japan Received for publication August 28, 2014; Accepted for publication September 16, 2014 Correspondence to Dr. Jiro Aoki, [email protected]
999
Intern Med 54: 999-1000, 2015
DOI: 10.2169/internalmedicine.54.4004
unsuccessful; therefore, emergency cricothyrotomy was performed. We diagnosed the patient to have angiotensinconverting enzyme inhibitor (ACE-I)-induced angioedema and therefore discontinued imidapril. He was thereafter treated with antihistamine and corticosteroid. The tongue swelling gradually subsided over the next 24 hours (Pic-
ture 3). Fiberoptic laryngoscopy before discharge revealed a normal oropharynx, supraglottis, and glottis (Picture 4). He was discharged after being advised not to take ACE-I. The authors state that they have no Conflict of Interest (COI).
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
1000
PICTURES IN CLINICAL MEDICINE
□
Life-Threatening Angioedema after Primary Percutaneous Coronary Intervention Hirono Homma, Jiro Aoki and Kengo Tanabe Key words: angioedema, ACE-I, myocardial infarction (Intern Med 54: 999-1000, 2015) (DOI: 10.2169/internalmedicine.54.4004)
Picture 2.
Picture 1.
Picture 4.
Picture 3.
A 69-year-old man was admitted due to acute myocardial infarction. After administering aspirin and clopidogrel, pri-
mary percutaneous coronary intervention (PCI) was performed and a coronary stent was successfully implanted. After PCI, imidapril hydrochloride, lovastatin, and carvedilol were additionally administered. Seven days after PCI, he presented with painless, nonpruritic tongue swelling, which had occurred after brushing his teeth. His tongue was markedly swollen and protruded from his mouth (Picture 1). Three hours later, he experienced difficulty in breathing. Fiberoptic laryngoscopy revealed oropharygeal edema that extended to the larynx (Picture 2). Nasotracheal intubation was
Division of Cardiology, Mitsui Memorial Hospital, Japan Received for publication August 28, 2014; Accepted for publication September 16, 2014 Correspondence to Dr. Jiro Aoki, [email protected]
999
Intern Med 54: 999-1000, 2015
DOI: 10.2169/internalmedicine.54.4004
unsuccessful; therefore, emergency cricothyrotomy was performed. We diagnosed the patient to have angiotensinconverting enzyme inhibitor (ACE-I)-induced angioedema and therefore discontinued imidapril. He was thereafter treated with antihistamine and corticosteroid. The tongue swelling gradually subsided over the next 24 hours (Pic-
ture 3). Fiberoptic laryngoscopy before discharge revealed a normal oropharynx, supraglottis, and glottis (Picture 4). He was discharged after being advised not to take ACE-I. The authors state that they have no Conflict of Interest (COI).
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
1000
