Acute Myocardial Infarction from Coronary Vasospasm Precipitated by Pseudoephedrine and Metoprolol Use

Can J Cardiol. 2017 May;33(5):688.e1-688.e3. doi: 10.1016/j.cjca.2017.01.005. Epub 2017 Jan 20.

Abstract

Pseudoephedrine is a sympathomimetic α- and β-adrenergic receptor agonist that causes vasoconstriction and reduction in edema throughout the nasal passages. Coronary vasospasm associated with pseudoephedrine has been reported in the literature. We discuss the case of a patient with new-onset atrial fibrillation receiving metoprolol for rate control on a background of pseudoephedrine use for allergic rhinitis leading to acute myocardial infarction from multivessel coronary vasospasm. This case illustrates the importance of understanding the pharmacology of potential drug-drug interactions when managing patients with acute cardiovascular syndromes.

Publication types

  • Case Reports

MeSH terms

  • Anti-Arrhythmia Agents / administration & dosage
  • Anti-Arrhythmia Agents / adverse effects
  • Asthma / complications
  • Asthma / drug therapy*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / adverse effects
  • Coronary Angiography / methods
  • Coronary Vasospasm* / chemically induced
  • Coronary Vasospasm* / diagnostic imaging
  • Electrocardiography / methods
  • Female
  • Humans
  • Metoprolol* / administration & dosage
  • Metoprolol* / adverse effects
  • Middle Aged
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / etiology
  • Myocardial Infarction* / physiopathology
  • Myocardial Infarction* / therapy
  • Nitroglycerin / administration & dosage*
  • Pseudoephedrine* / administration & dosage
  • Pseudoephedrine* / adverse effects
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage

Substances

  • Anti-Arrhythmia Agents
  • Bronchodilator Agents
  • Vasodilator Agents
  • Pseudoephedrine
  • Nitroglycerin
  • Metoprolol