Myocardial ischemia and stunning induced by topical intranasal phenylephrine pledgets

This case study describes myocardial ischemia and stunning after the topical application of phenylephrine-soaked pledgets (0.25%) in a 63-year-old female undergoing elective endoscopic sinus surgery. The patient had no previous history of cardiovascular disease or illicit drug use. Transient myocardial ischemia was associated with acute hypertension, chest pain, and S-T segment changes 4 minutes after pledget placement. Angiography revealed normal coronary blood flow and severe left ventricular systolic and diastolic dysfunction. Follow-up echocardiography demonstrated improved left ventricular function within 1 week and total resolution of dysfunction by 4 weeks after ischemia.