[Asymptomatic electrical myocardial necrosis during the infusion of betamimetics in status asthmaticus]

A case is reported of a 56 year old woman admitted for status asthmaticus. She had no known history of cardiovascular disease. During the infusion of salbutamol, there appeared signs of myocardial infarction on the ECG trace. The patient did not complain of any symptoms suggestive of myocardial infarction. Closer cardiac examination and ultrasound revealed features of hypertrophic cardiomyopathy. The first ECG carried out on admission was in fact in favour of this diagnosis. The pathogenesis of this myocardial infarction is discussed: the long lasting hypoxaemia and the tachycardia induced by the salbutamol simulated hard exercise, poorly tolerated by patients suffering from hypertrophic cardiomyopathy. Also, this type of cardiomyopathy is known to be associated with impaired myocardial vasodilator reserve and small vessel coronary artery disease.