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Pediatric myocardial infarction after racemic epinephrine administration

M J Butte1, B X Nguyen, T J Hutchison

  • 1Graduate Group in Biophysics, University of California San Francisco, San Francisco, California, USA.

Pediatrics
|July 2, 1999
PubMed

Insights

A rare myocardial infarction complication occurred in a child treated with racemic epinephrine for croup. This study highlights the need for careful monitoring during emergency respiratory distress treatments.

Area of Science:

  • Pediatric Emergency Medicine
  • Cardiology
  • Pharmacology

Background:

  • Racemic epinephrine is frequently used in emergency departments for severe respiratory distress in pediatric patients with croup or bronchiolitis.
  • While generally safe, potential adverse cardiovascular events require ongoing investigation.

Observation:

  • A pediatric patient receiving multiple doses of nebulized racemic epinephrine for croup experienced ventricular tachycardia and chest discomfort.
  • Initial cardiac assessments revealed abnormal electrocardiograms and elevated creatine phosphokinase MB isoenzyme (CPK-MB) levels.

Findings:

  • Diagnostic evaluations, including echocardiography and cardiac catheterization, showed a structurally normal heart and coronary arteries.
  • A stress nuclear study confirmed a small myocardial infarction, a previously unreported complication of racemic epinephrine treatment.

Implications:

  • This case suggests a potential link between racemic epinephrine administration and myocardial infarction in pediatric patients.
  • Highlights the importance of cardiac monitoring during racemic epinephrine therapy for severe respiratory distress.
  • Recommends cautious use and consideration of cardiac complications in the emergency department setting.

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