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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

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Published on: August 18, 2016

Smells like a heart attack, but is it?

David R Warriner¹, Paul Morris, Vipul Ramjiani

¹Medical Physics Department, Sheffield University, Sheffield, UK. d.r.warriner@sheffi eld.ac.uk

BMJ Case Reports

|June 7, 2012

Summary

This summary is machine-generated.

A rare case of methaemoglobinaemia, a condition affecting oxygen transport, mimicked acute myocardial infarction. This occurred after inhaling smelling salts, highlighting a unique diagnostic challenge.

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Area of Science:

Cardiology
Toxicology

Background:

Acute myocardial infarction (AMI) is a prevalent cardiovascular emergency.
Methaemoglobinaemia is a rare condition characterized by elevated levels of methaemoglobin.
Differentiating methaemoglobinaemia from AMI is critical due to distinct management strategies.

Observation:

A middle-aged male presented with symptoms suggestive of AMI, including chest pain, cyanosis, and tachycardia.
Initial cardiac assessments, including ECG and echocardiogram, were unremarkable.
Arterial blood gas analysis revealed significant methaemoglobinaemia (28.5%).

Findings:

The patient's methaemoglobinaemia normalized spontaneously.
The condition was attributed to the inhalation of smelling salts, commonly used as stimulants.
This represents the first reported instance of smelling salts inducing methaemoglobinaemia and mimicking AMI.

Implications:

This case underscores the importance of a comprehensive diagnostic approach, considering toxicological causes for cardiac-like symptoms.
Clinicians should be aware of methaemoglobinaemia as a potential mimic of AMI, especially with a history of stimulant use.
Early recognition and diagnosis of methaemoglobinaemia are crucial to avoid unnecessary and potentially harmful cardiac interventions.