An adult man underwent coronary computed tomography angiography (CTA) to evaluate intermittent chest tightness with normal electrocardiogram (ECG). One minute after undergoing CTA, he developed shortness of breath, wheezing, flushing, and then loss of consciousness, with heart rate and blood pressure dropping to 50 bpm and 60/45 mm Hg, respectively, within 5 minutes. He was treated with 1 mg of epinephrine (1:1000) by intravenous (IV) bolus. A few minutes later, he regained consciousness but developed chest discomfort, with new-onset ST elevation in leads II, III, and aVF and ST depression in leads I, aVL, and V1 through V3 (Figure).
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Jiang C, Li H. Electrocardiographic Changes After Overdose of Epinephrine in a Patient With Anaphylaxis: Kounis Syndrome or Epinephrine? JAMA Intern Med. Published online May 13, 2019179(7):973–974. doi:10.1001/jamainternmed.2019.1230
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