title: An unusual adverse effect of sildenafil citrate: acute myocardial infarction in a nitrate-free patient.
abstract: Myocardial infarction (MI) associated with sildenafil citrate is seen rarely in patients without any history of coronary artery disease. We report a nitrate-free patient with a history of cardiovascular risk factors who developed acute MI after taking sildenafil. A 44-year-old man diagnosed with acute anterior ST segment elevation MI 120 min after self-administration of 150 mg sildenafil was admitted before attempting any sexual intercourse. The coronary angiography revealed 99% occlusion of the left anterior descending artery (LAD) and a bare-metal stent was implanted. He was discharged after 5 days without any complication. Sildenafil may cause coronary steal or may lead to vasodilation causing hypotension in patient with pre-existing cardiovascular disease, especially in patients on nitrate therapy. Our patient was nitrate free, with normal blood pressure values. Emotional stimulation associated with anticipated sexual activity may have been a triggering factor for vulnerable coronary plaque rupture.
authors.affiliation: Department of Cardiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. altugcakmak@hotmail.com
authors.forename: Huseyin Altug
authors.initials: HA
authors.lastname: Cakmak
authors.forename: Baris
authors.initials: B
authors.lastname: Ikitimur
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Karadag
authors.forename: Zeki
authors.initials: Z
authors.lastname: Ongen
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003075:Coitus / Q000523:psychology; D054059:Coronary Occlusion / Q000150:complications* / Q000601:surgery; D003331:Coronary Vessels / Q000187:drug effects* / Q000601:surgery; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000523:psychology / Q000601:surgery; D009566:Nitrates / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects*; D011687:Purines / Q000009:adverse effects; D012307:Risk Factors; D000068677:Sildenafil Citrate; D015607:Stents; D013450:Sulfones / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000009:adverse effects*
chemical_list: D009566:Nitrates; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate