Myocardial infarction associated with the administration of intravenous ephedrine and metaraminol for spinal-induced hypotension.
A 31-year-old female with no risk factors for cardiac disease suffered a peri-operative myocardial infarction during an elective gynaecological procedure under spinal anaesthesia. The timing and nature of cardiac symptoms suggest that the myocardial infarction was caused by coronary artery vasospasm secondary to ephedrine and/or metaraminol, which were administered to treat spinal-induced hypotension. We review the recent literature and case reports on myocardial infarction attributed to sympathomimetic drugs, and recommend the use of sublingual or intravenous nitrates when signs or symptoms of coronary arterial vasospasm become evident during their use.
Khavandi
A
A
Department of Cardiology, Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK.
Gatward
J J
JJ
Whitaker
J
J
Walker
P
P
D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004809:Ephedrine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D008680:Metaraminol / Q000009:adverse effects* / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000139:chemically induced*; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D008680:Metaraminol; D004809:Ephedrine