Related Experiment Video
Updated: Dec 21, 2025
07:59
Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration
Published on: April 4, 2022
1.6K
Recurrent ST Elevation Myocardial Infarction from Norepinephrine-induced Coronary Vasospasm
Raed Qarajeh1, Annapoorna Singh1, Yevgeniy Khariton2
1Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Cureus
|May 14, 2020
Summary
Myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) can be triggered by norepinephrine-induced coronary vasospasm. This case highlights a rare cause of MINOCA, emphasizing vasospasm
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) is defined by myocardial infarction evidence and normal coronary arteries.
- Coronary artery spasm, often termed "variant angina," typically affects localized epicardial artery segments.
Observation:
- A 58-year-old male experienced ST elevation myocardial infarction on two separate hospital admissions.
- The myocardial infarction events were linked to norepinephrine administration.
Findings:
- The patient presented with ST elevation myocardial infarction despite having normal coronary arteries on angiography.
- Norepinephrine administration was identified as the trigger for coronary vasospasm leading to MINOCA.
Implications:
- This case underscores coronary vasospasm as a potential cause of MINOCA, even when induced by medications like norepinephrine.
- Recognizing drug-induced vasospasm is crucial for diagnosing and managing MINOCA patients.
- Further research into medication-induced coronary vasospasm in MINOCA is warranted.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
289
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
289
01:30Acute Coronary Syndrome I: Introduction
564
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
564
01:30Acute Coronary Syndrome III: Diagnostic Studies
143
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
143
01:27Angina II: Classification
204
Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
204
01:21Myocarditis I: Introduction
273
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
273
01:28Acute Coronary Syndrome IV: Interprofessional Care
161
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
161