Acute Severe Urticaria and Angioedema Leading to Myocardial Infarction

HISTORY OF PRESENT ILLNESS One week before this admission, he was treated in the emergency department for angioedema of the hands and generalized urticaria. This lasted for about three days and was treated with oral diphenhydramine. No specific triggering factor was found. Approximately eight hours prior to the onset of the current episode of chest pain, he began to experience itching and swelling of face and hands. Despite taking 50 mg diphenhydramine orally, the itching worsened and he developed generalized urticaria. The swelling of his face and eyes progressed until the eyes were almost shut. He was treated with intravenous corticosteroid (125 mg methylprednisolone), H2 blocker (20 mg famotidine), and intramuscular H1 blocker (50 mg diphenhydramine) in the emergency department. He returned home from the hospital with the urticaria and the swelling still present. Two and one-half hours later, he felt substernal chest pain and returned to the emergency department. Medications He had been taking lovastatin, 20 mg qd, and ranitidine, 150 mg bid, for 3 years; enteric coated aspirin, qd for 2 years; etodolac, 300 mg tid for 3 months; vitamin C and E tablets qd for 2 months; garlic and cod liver oil tablets for 3 weeks; beta carotene and selenium tablets off and on for several weeks.