title: Acute Myocardial Infarction from Coronary Vasospasm Precipitated by Pseudoephedrine and Metoprolol Use.
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.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Meoli
authors.affiliation: Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Goldsweig
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Cardiology Department, VA Connecticut Healthcare System, West Haven, Connecticut, USA. Electronic address: brian.malm@yale.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Malm
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D017023:Coronary Angiography / Q000379:methods; D003329:Coronary Vasospasm / Q000139:chemically induced / Q000000981:diagnostic imaging; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008790:Metoprolol / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005996:Nitroglycerin / Q000008:administration & dosage*; D054199:Pseudoephedrine / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D000889:Anti-Arrhythmia Agents; D001993:Bronchodilator Agents; D014665:Vasodilator Agents; D054199:Pseudoephedrine; D005996:Nitroglycerin; D008790:Metoprolol