RESUMEN
A 53-year-old man with inotrope-dependent advanced heart failure was admitted with acute decompensation and underwent urgent listing for heart transplant.
Asunto(s)
Insuficiencia Cardíaca , Contrapulsador Intraaórtico , Humanos , Masculino , Persona de Mediana Edad , Contrapulsador Intraaórtico/métodos , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/métodos , Arteria Femoral/cirugía , Resultado del Tratamiento , Atención Ambulatoria/métodosRESUMEN
Introduction: In the realm of organ transplantation, particularly heart transplantation, angioedema presents a significant challenge. This clinical condition ranges from minor facial edema to life-threatening swelling of vital structures. Its multifactorial etiology involves various factors and mechanisms, including C1 esterase inhibitor deficiency, food allergen hypersensitivity, and adverse drug reactions, notably involving angiotensin-converting enzyme (ACE) inhibitors and mechanistic target of rapamycin inhibitors (mTOR-Is). We present a rare case of sirolimus potentiated angioedema in a patient with long-standing ACE inhibitor therapy. Case: A 52-year-old male with a history of heart transplant developed severe upper and lower lip edema. The patient had been on Lisinopril without any adverse events. However, sirolimus was recently added to his drug regimen. Sirolimus potentiated angioedema was suspected. Intervention: Intravenous methylprednisolone, famotidine, and diphenhydramine were initiated, and both lisinopril and sirolimus were discontinued. The patient showed improvement and was discharged with oral antihistamines. Lessons: Transplant physicians should be aware of the life-threatening interaction between ACE inhibitors and mTOR-Is like sirolimus. Consideration should be given to switching from an ACE inhibitor to an angiotensin-receptor blocker when initiating patients on mTOR-Is.
RESUMEN
A 39-year-old man with non-ischemic cardiomyopathy presented for routine right heart catheterization.
