ST Elevation Myocardial Infarction Presenting After Use of Pseudoephedrine

Pseudoephedrine bearing products are widely used as decongestant in common cold. Its sympathomimetic effects are similar to ephedrine and, by stimulating adrenergic receptors, can increase arterial blood pressure through both peripheral vasoconstriction and cardiac stimulation [1]. There is a growing suspicious about these products because of their possible cardiovascular effects including hypertensive crisis [2], stroke [3], and acute coronary syndromes [2, 4–11]. A 33-year-old non-smoking man was admitted with chest pain for 3 h following ingestion of pseudoephedrine bearing drug (500 mg paracetamol, 4 mg chlorpheniramine, and 60 mg pseudoephedrine) and diagnosed as inferolateral ST elevation acute coronary syndrome in emergency service (Fig. 1—left). After thrombolytic and medical therapy as recommended in current guidelines, ST elevation and chest pain resolved (Fig. 1—right). The observation of concomitant cardiac troponin elevations leads to the final diagnosis of myocardial infarction (initially negative, 2.1 ng/ml 4 h after thrombolytic therapy). Coronary angiogram revealed normal coronary arteries (Fig. 2), possibly suggesting a mechanism of alphaadrenergic stimulation leads to coronary vasospasm caused by pseudoephedrine and endothelial dysfunction and prothrombotic state caused by infection. This case shows the potential danger of the pseudoephedrine bearing medications that may lead to even myocardial infarction.