Heart Attack

[jneu6684]

Dear Doctor, thank you in advance. 40 YO WF, 4'11", 115. FH of HTN & strokes. Personal HTN for 20 years on/off meds. Low HDL of 26 (TC 130, trigly 175 mg/dl, LDL 69, VLDL 35, C/HDL 5), sedentary lifestyle. I took one cephalexin for a bad tooth that needs to be pulled. Within 30 min my palms and soles began to itch. Allergy to most antibiotics. Bright red rash all over, rush/flush through my body, syncope times 4, total incontinence, nausea, sweats and then cold. Family doc could not get me in next day so went to ER. My enzymes: CPK 529 U/L on arrival/peak  601/301 @ 24 hr. CK-MB 75.2 ng/mL on first draw/peak 85.2/30.6 @ 24 hr. CMB% 14.2 on arr/peak/10.2 @ 24 hr. D-Dimer 2985. TPN I on arr 10.84 ng/mL/to 24.31/down @ 11.45 @ 24 hr. EKG arrival showed early transition, QRS positive in V2, diffuse T-wave ab, Q waves inf leads  8 h later anterolateral T-wave ab, > - 0.30 mV in I, aVL, V2-V6 and @ 24 hr early transition, QRS positive in V2, diffuse NS T-wave ab/T-waves - 0.10 mV ANT, LAT and INF with inferior Q-waves 2, 3, F, add to 80 mS. Echos x 2 norm, EF 60. INR 1.1, PTT 36.2, protime 13.6 in ER. Homocysteine 10.3 @ 24 hr. Cath only 40% RCA stenosis with acute plaque rupture. Told no correlation between antibiotic & MI. Also, with immuno response in WBC 14.3, granulocytes 84.1, monocytes 2.8. These back to normal @ 24 hr.  I realize I still had a heart attack regardless and I am pursing all that entails, taking meds, changing lifestyle & eating habits and starting cardiac rehab.  Please see my comment post following for my questions, sorry just couldn't get it all in!

[CCF-M.D.-RCJ]

Jneu6684,

Thanks for the post.

You clearly had a heart attack, and so need appropriate therapy, which may include beta-blockers, ACE-inhibitors, aspirin, clopidogrel, statin therapy, among others.

Anaphylaxis is a clinical diagnosis.  It certainly sounds possible that you had an anaphylactic reaction, but I did not evaluate you at that time.  An easy way to get at whether or not you are allergic to the antibiotic is to see an allergist for testing.  Further information regarding the events may also help the allergist decide if indeed you had anaphylaxis.

Determining "size" of a heart attack depends on many things, but the bottom line is how a person feels now when trying to be active.

Humans want to make associations and place blame.  It would be convenient to blame the heart attack on the anaphylactic reaction, if there was one, but the reality is that you will never really know.

Good luck.

[jneu6684]

Sorry - here's the questions.

What is your opinion regarding CAD versus anaphylactic reaction; have you heard of anything like this before?  

If anaphylaxis, do you think I need to a get a second opinion, as my current cardiologist does not seem open to discussing this?  (Aren't the two very different and require different medical treatments - like not being on ACE inhibitors or beta-blockers if truly anaphylaxis and how will that affect treating me for the recent MI?)

Shouldn't my records reflect this antibiotic?

In the hospital, the nurses continually made my heart attack seem "huge" - making statements such as "if you could see your numbers" when I asked "is it really that bad" because they wouldn't even let me get up to use the restroom.  Were my numbers fairly high for an MI or pretty average?  If the numbers were fairly high and there was very little damage done wouldn't that again argue for the anaphylaxis - as it would have had a large insult but was reperfused very quickly?

HELP!  Anything you can shed light on with all of this for me would be so greatly appreciated!  Thank you!  Thank you!

[nurse12hr]

I just had to comment about one thing:

If I were you, I would NEVER take Cefalexin again.  Never would probably be too soon!

Why risk it?  From now on, when asked about allergies, tell them you are allergic to it.  
Certainly sounds like anaphalaxis to me.  I would think it was possible that the severe vasospasm resulting from a severe allergic reaction could have caused a coronary event.

But, as you pointed out, doesn't really matter in the long run.  You have started to make the necessary lifestyle changes, and bravo!

But in my nonmedical opinion, you ARE allergic.  (I had much the same reaction to Penicillin and a cephalosporin drug.  Within 10 min of taking it, severe itching palms, the rash, then hives and wheezing.  Dramatic.  I don't need anymore proof than that, personally)

[jneu6684]

Thanks Christie, yes I agree, I will never take that again for sure without doubt.  But, I did not say that it makes no difference in the long run - my "reason" for wanting to know about whether I had an anaphlactic reaction or not was two-fold -one, because I wonder if I necessarily need to be on all the heart medication indefinitely, which, according to research I did, will actually "inhibit" treatment of an anaphylactic reaction should I have another, which is likely due to my multitude of allergies to medications.  Secondly, there is a big difference to insurance companies and so on regarding a heart attack from "documented coronary artery disease," which I have been attributed as having now, versus an anaphylactic reaction from medication - which could mean the difference between my being able to get insurance in the future.  Its not that I want to place "blame" or anything like that - I simply want to have appropriate treatment for the condition I do or don't have and be able to get insurance in the future.

[nurse12hr]

OK, I get it.

That's a tough one.  Good luck researching it.

[singva]

here is some information about a patient:
   repeatedly chest pain five years.
   The suffer has pain in the chest repeatedly which go down his shoulder at rest and disapears in doing exercises since five years ago .The pain is stable and can be relieved by taking nitroglycerin. No fever,nauser,vomit or other sysmptoms have been domenstrated ever since . A CAG was taken in Guangdong Hospital in 1998 and a nagative result was given.The chest CT also had a nagative result. The result of ECT taken in 2000 indicate slightly myocardial ischemia.
   Here,I have some question to ask. Which disease must be most possible the suffer suffering from and to get a definitive diagnosis whatelese check should be taken? Does any hospital or expert have experience in dealing with case like this and any advice can be given? Appreplies. Thanks