title: Pneumonitis and pulmonary haemorrhage after acute myocardial infarction.
abstract: A 55-year-old man presented with acute ST-elevation myocardial infarction. He received rescue angioplasty with one drug eluting stent. He developed marked breathlessness and haemoptysis two days later. Investigations led to the diagnosis of pulmonary haemorrhage, possibly from pneumonitis caused by ticagrelor. He was successfully managed with high-dose steroids and ticagrelor was replaced with clopidogrel. On stopping the steroids a month later, mild haemoptysis recurred and this was managed conservatively. Pneumonitis and pulmonary haemorrhage is rarely reported with acute myocardial infarction, but poses serious challenge to the patient and the clinician. Diagnosis may be delayed as breathlessness can occur due to myriad causes after myocardial infarction. Interrupting dual anti-platelet therapy after angioplasty could lead to devastating stent thrombosis.
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK s.parasuraman@uea.ac.uk.
authors.forename: Sathish K
authors.initials: SK
authors.lastname: Parasuraman
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Alison Ic
authors.initials: AI
authors.lastname: Teo
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Colin Gm
authors.initials: CG
authors.lastname: Millar
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Awsan
authors.initials: A
authors.lastname: Noman
mesh_terms: D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D017130:Angioplasty; D006469:Hemoptysis; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011014:Pneumonia; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D013902:Radiography, Thoracic; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control; D000077486:Ticagrelor
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine
keywords: Pulmonary haemorrhage; myocardial infarction; pneumonitis; steroid therapy; ticagrelor