Enders Jason M, Dobesh Paul P, Ellison James N
Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO 63110-1088, USA.
Pharmacotherapy. 2003 Dec;23(12):1645-51. doi: 10.1592/phco.23.15.1645.31959.
A 45-year-old woman was hospitalized to rule out acute myocardial infarction after coming to the emergency department with a complaint of substernal chest pressure. Her initial electrocardiogram indicated normal sinus rhythm with T-wave inversion and nonspecific ST changes suggestive of possible ischemia. She had no medical problems and took no prescription drugs. Further evaluation revealed that for approximately 4 years she had been taking Metabolife 356 preparations--a source of ephedrine alkaloids--for weight loss, and that she was at low risk for atherosclerotic coronary artery disease. Due to elevated cardiac markers, cardiac catheterization was performed, which revealed no atherosclerosis in the coronary arteries. The patient's acute myocardial infarction was attributed to coronary artery vasospasm induced by ephedrine alkaloids. Clinicians should be aware of the growing evidence that supports life-threatening cardiovascular toxicities associated with these substances.
一名45岁女性因主诉胸骨后胸部压迫感前往急诊科，为排除急性心肌梗死而住院。她最初的心电图显示窦性心律正常，T波倒置以及非特异性ST段改变，提示可能存在心肌缺血。她没有其他疾病，也未服用处方药。进一步评估发现，她服用含有麻黄碱生物碱的Metabolife 356制剂进行减肥约4年，且患动脉粥样硬化性冠状动脉疾病的风险较低。由于心肌标志物升高，进行了心脏导管检查，结果显示冠状动脉无动脉粥样硬化。该患者的急性心肌梗死归因于麻黄碱生物碱引起的冠状动脉痉挛。临床医生应意识到越来越多的证据支持这些物质会引发危及生命的心血管毒性。
