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[Myocardial infarction following rapid perfusion of corticoids]
A Cerisier1, A Dacosta, F Dubois
1Service de cardiologie, CHU Nord, Saint-Etienne.
Insights
High-dose corticosteroids for multiple sclerosis relapse can cause immediate myocardial infarction. Careful cardiac monitoring during infusion is crucial to detect and manage this rare but serious adverse effect.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Corticosteroids are frequently used to manage multiple sclerosis relapses.
- Potential cardiovascular side effects of corticosteroids, though rare, can be severe.
Observation:
- A patient experienced myocardial infarction immediately following rapid intravenous high-dose corticosteroid infusion for a multiple sclerosis relapse.
- Ventriculography revealed myocardial damage, but coronary arteries were normal, and other etiological investigations were negative.
Findings:
- This case highlights a rare instance of corticosteroid-induced coronary insufficiency, with only three prior reports.
- The exact mechanisms leading to infarction in this context require further investigation.
Implications:
- Routine electrocardiogram (ECG) before and during corticosteroid infusions is recommended.
- Continuous ECG monitoring and extended hospital admission may be necessary for patients receiving high-dose corticosteroids to mitigate cardiac risks.
Abstract:
The authors report the case of myocardial infarction occurring immediately after rapid intravenous infusion of a high dose of corticosteroids prescribed for a relapse of multiple sclerosis. Ventriculography confirmed the myocardial damage but the coronary arteries were normal. An aetiological investigation was negative. The authors review the cardiac secondary effects which may be very serious and even fatal. Coronary insufficiency is rare (only 3 previously published cases); it is therefore difficult to determine the prognosis. The possible mechanisms of infarction are discussed. Finally, the authors underline the importance of recording an ECG before treatment, of ECG monitoring during the infusion, and the need for repeating the recordings and of prolonging hospital admission when necessary.