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.
Subject(s)
Bupropion/adverse effects , Dopamine Uptake Inhibitors/adverse effects , Ephedrine/adverse effects , Myocardial Infarction/chemically induced , Sympathomimetics/adverse effects , Adult , Bronchitis/drug therapy , Bupropion/therapeutic use , Dopamine Uptake Inhibitors/therapeutic use , Drug Interactions , Ephedrine/therapeutic use , Humans , Male , Myocardial Infarction/diagnosis , Sympathomimetics/therapeutic useABSTRACT
Seventy patients undergoing aortocoronary bypass grafting were randomized, double-blind, to receive either atenolol or placebo. There were 35 patients in each group. Patients received either atenolol 5 mg intravenously or matching placebo within 3 h of the completion of surgery. A second intravenous dose was administered 24 h following the first and then atenolol 50 mg orally or matching placebo was given for six days. Continuous Holter monitor recordings were obtained for the 24 h immediately preoperatively and continuously for eight days postoperatively. No patient received any antiarrhythmic drug preoperatively. Patients who required pharmacological intervention for the management of postoperative arrhythmias were withdrawn as treatment failures. Holter monitor analysis continued for 24 h following withdrawal of a treatment failure. All patients were analyzed according to the intention-to-treat principle. Both groups were comparable with respect to age, sex, severity of coronary artery disease, left ventricular ejection fraction, preoperative use of beta-blockers, bypass time, aortic cross-clamp time, number of grafts per patient and frequency of preoperative arrhythmias. Arrhythmia analysis was done manually. Supraventricular arrhythmias (atrial tachycardia, atrial fibrillation and atrial flutter) were classified as either mild (less than 0.5 mins, less than 140 beats/min), moderate (0.5 to 30 mins, 140 to 180 beats/min), or severe (longer than 30 mins, more than 180 beats/min). Ventricular arrhythmia analysis was performed with respect to isolated PVCs, couplets, triplets and episodes of nonsustained ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Atenolol/therapeutic use , Coronary Artery Bypass/adverse effects , Tachycardia, Supraventricular/prevention & control , Aged , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Middle Aged , Random Allocation , Tachycardia, Supraventricular/etiologyABSTRACT
This paper describes recent advances in invasive cardiology that enable the primary-care physician to offer his/her patient a wider range of effective treatments. Major developments in the investigation and management of the acute coronary syndromes, unstable angina and myocardial infarction, have revolutionized the care of patients with these conditions. The primary-care physician must be aware of the treatment modalities, the lines of referral, and strategies for management available in his/her clinical setting to allow prompt application of these modalities. A sampling of exciting advances in other areas of invasive cardiology are also described.
