Myocardial Infarction Induced by Refrigerant (Hydrofluorocarbon (HFC)-134a) Exposure: A Case Report

Refrigerants such as hydrofluorocarbon (HFC)-134a (1,1,1,2-tetrafluoroethane) are widely used in refrigeration and air-conditioning systems. While their toxic effects are generally considered low, cardiotoxicity associated with arrhythmias has been reported. However, to the best of our knowledge, myocardial infarction (MI) immediately following refrigerant exposure has not been documented in the literature until now. We report the case of a 75-year-old man with coronary artery disease, an assistant professor at a community college specializing in refrigeration technology and heating, ventilation, and air conditioning (HVAC) standards. He was exposed to HFC-134a while repairing a leak in an antique refrigeration unit when he experienced a sudden onset of dyspnea and mild chest pain. He presented to the emergency department, where workup revealed worsening T-wave abnormalities compared to an electrocardiogram (EKG) taken two months prior, along with elevated troponin levels, confirming an acute MI. The patient was placed on supplemental oxygen and stabilized with antihypertensives and nitroglycerin. This case highlights a potential association between acute refrigerant exposure and MI, a novel finding not previously reported. Possible mechanisms include cardiac sensitization to epinephrine or hypoxia-induced ischemia, although acute stress-related MI cannot be ruled out, especially with the patient's underlying conditions. Further research is needed to explore the cardiotoxic potential of refrigerants, particularly in individuals with preexisting coronary artery disease.