title: Acute myocardial ischemia associated with ingestion of bupropion and pseudoephedrine in a 21-year-old man.
abstract: A 21-year-old man presented to the emergency department with atypical chest pain, diaphoresis and shortness of breath. His electrocardiogram revealed ST segment elevation in leads II, III, aVF, V5 and V6, elevated creatine kinase-MB subunit levels and positive troponin I. He denied the use of cocaine, and smoking was his only risk factor for coronary artery disease. The patient was diagnosed with an acute myocardial infarction, yet an emergency coronary angiogram revealed normal coronary arteries. His medication history revealed recent commencement of bupropion for smoking cessation and pseudoephedrine as a nonprescription influenza remedy. It was postulated that this patient experienced acute coronary vasospasm in the presence of these two known sympathomimetic agents. The present case is the first report linking bupropion to an acute coronary syndrome, and one of a few cases associated with pseudoephedrine.
authors.affiliation: University of Saskatchewan, Saskatoon, Canada.
authors.forename: K J
authors.initials: KJ
authors.lastname: Pederson
authors.forename: D H
authors.initials: DH
authors.lastname: Kuntz
authors.forename: G J
authors.initials: GJ
authors.lastname: Garbe
mesh_terms: D000328:Adult; D001991:Bronchitis / Q000188:drug therapy; D016642:Bupropion / Q000009:adverse effects* / Q000627:therapeutic use; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D004809:Ephedrine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis; D013566:Sympathomimetics / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018765:Dopamine Uptake Inhibitors; D013566:Sympathomimetics; D016642:Bupropion; D004809:Ephedrine