History: A 32-year-old, very slightly overweight woman (body mass index of 25) without any cardiovascular risk factors presented with acute chest pain. She reported taking the appetite suppressant sibutramine daily for three months. She was not pregnant and did not remember episodes of serious mental stress or infection during the last few weeks. Physical examination was unsuspicious.
Investigation: Laboratory results revealed an elevation of serum markers of myocardial ischemia. The electrocardiogram showed ST segment depressions and T wave inversions in leads II, III and aVF, indicating a nontransmural inferior myocardial infarction.
Treatment and course: Coronary angiography showed patent coronary arteries with inferior wall hypokinesia. There were no signs of a coronary dissection. Assuming that the acute coronary syndrome had been induced by coronary spasms, the patient was treated with amlodipine and ramipril.
Conclusion: It seemed reasonable to suspect that the intake of sibutramine had induced coronary spasms. However, this is a diagnosis of exclusion. Three case reports have previously been published about acute myocardial infarctions, possibly related to sibutramin intake, in young patients with a negligible cardiovascular risk profile. The European Medicines Agency has questioned the marketing authorisations for sibutramine (January 2010). In patients presenting with acute coronary syndromes which can not be clearly related to cardiovascular risk factors, it is crucial to obtain a complete drug history. Some patients might continue to take sibutramine.
Georg Thieme Verlag KG Stuttgart * New York.