Falcón-Chévere Jorge L, Cabañas José G, Canales-Colón Idaliz, Martorell-Millan Guillermo
University of Puerto Rico School of Medicine, Emergency Medicine Department.
Bol Asoc Med P R. 2007 Oct-Dec;99(4):325-30.
Sildenafil citrate is a drug used in the treatment of erectile dysfunction. It is an inhibitor of the enzyme phosphordiesterase-5; it slows down the breakdown of c-GMP and nitrous oxide. The cardiac effects associated with Sildenafil citrate have been extensively studied in medical literature, especially its potent vasodilatory effect when combined with nitrate-based medications, producing intractable hypotension, but a lesser known and potentially lethal side effect is prolonged cardiac repolarization when used at dosage greater than recommended, leading to QT prolongation that could theoretically lead to dangerous cardiac dysrrhythmias and sudden death in men with coronary artery disease. The authors present the case of a 49-year-old hypertensive Hispanic man who arrived to our emergency department with the chief complaint of acute epigastric pain for 3 hours of evolution after ingestion of Sildenafil citrate 50 milligrams (mg). The patient was found to have an acute ST elevation inferior myocardial infarction (STEMI). Shortly after diagnosis the patient developed a polymorphic ventricular tachycardia (Torsade de pointes) before thrombolytic administration. We present this case followed by a brief discussion, to heighten awareness of the possible association of acute inferior STEMI and the development of Torsade de Pointes after the use of Sildenafil citrate.
枸橼酸西地那非是一种用于治疗勃起功能障碍的药物。它是磷酸二酯酶-5的抑制剂；能减缓环磷酸鸟苷（c-GMP）和一氧化氮的分解。医学文献中已对枸橼酸西地那非的心脏效应进行了广泛研究，尤其是其与硝酸酯类药物合用时的强效血管舒张作用会导致顽固性低血压，但一种鲜为人知且可能致命的副作用是，当使用剂量超过推荐剂量时会延长心脏复极化，导致QT间期延长，理论上这可能会导致患有冠状动脉疾病的男性出现危险的心律失常和猝死。作者报告了一名49岁的西班牙裔高血压男性病例，该患者因服用50毫克枸橼酸西地那非后出现3小时急性上腹部疼痛为主诉前来我院急诊科就诊。患者被诊断为急性下壁ST段抬高型心肌梗死（STEMI）。诊断后不久，患者在溶栓治疗前出现了多形性室性心动过速（尖端扭转型室速）。我们呈现此病例并进行简要讨论，以提高对使用枸橼酸西地那非后急性下壁STEMI与尖端扭转型室速可能关联的认识。
