Myocardial infarction with normal coronary arteriogram: the role of ephedrine-like alkaloids

The overwhelming majority of myocardial infarctions result from atherosclerosis, generally with superimposed coronary thrombosis. The prevalence of patients who develop myocardial infarction and in whom subsequent angiography shows normal coronary arteries is approximately 5%. Many of these cases are caused by coronary artery spasm and/or thrombosis, perhaps with an underlying endothelial dysfunction of the epicardial coronary arteries.

The authors present a case of acute myocardial infarction with normal coronary arteriogram which occurred in a 19-year-old, cigarette-smoking male following usage of a pseudoephedrine-containing drug for an upper respiratory tract infection. Coronary artery spasm, associated with taking pseudoephedrine, and a prothrombotic state, related to the platelet and endothelial effects of cigarette smoking and infection, were the possible mechanisms of myocardial infarction in the reported case.

A diagnosis of acute myocardial infarction should be seriously considered even in relatively young tobacco-smoking patients, especially after acute alcohol intoxication or cocaine, amphetamine or ephedrine exposure. It is very important to obtain a complete history of the use of such 'safe' drugs, which do not need to be administered by a doctor but may contain treacherous components. These data provide the necessary background for making an accurate diagnosis and appropriate decisions concerning therapy.