Pöss Janine, Böhm M, Link A
Kardiologie, Angiologie und internistische Intensivmedizin, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar.
Dtsch Med Wochenschr. 2010 May;135(19):965-8. doi: 10.1055/s-0030-1253684. Epub 2010 May 5.
A 32-year-old, very slightly overweight woman (body mass index of 25) without any cardiovascular risk factors presented with acute chest pain. She reported taking the appetite suppressant sibutramine daily for three months. She was not pregnant and did not remember episodes of serious mental stress or infection during the last few weeks. Physical examination was unsuspicious.
Laboratory results revealed an elevation of serum markers of myocardial ischemia. The electrocardiogram showed ST segment depressions and T wave inversions in leads II, III and aVF, indicating a nontransmural inferior myocardial infarction.
Coronary angiography showed patent coronary arteries with inferior wall hypokinesia. There were no signs of a coronary dissection. Assuming that the acute coronary syndrome had been induced by coronary spasms, the patient was treated with amlodipine and ramipril.
It seemed reasonable to suspect that the intake of sibutramine had induced coronary spasms. However, this is a diagnosis of exclusion. Three case reports have previously been published about acute myocardial infarctions, possibly related to sibutramin intake, in young patients with a negligible cardiovascular risk profile. The European Medicines Agency has questioned the marketing authorisations for sibutramine (January 2010). In patients presenting with acute coronary syndromes which can not be clearly related to cardiovascular risk factors, it is crucial to obtain a complete drug history. Some patients might continue to take sibutramine.
一名32岁、体重略超重（体重指数为25）且无任何心血管危险因素的女性因急性胸痛前来就诊。她报告称每日服用食欲抑制剂西布曲明，持续了三个月。她未怀孕，也不记得过去几周内有过严重精神压力或感染发作。体格检查未发现异常。
实验室检查结果显示心肌缺血的血清标志物升高。心电图显示II、III和aVF导联ST段压低及T波倒置，提示非透壁性下壁心肌梗死。
冠状动脉造影显示冠状动脉通畅，但下壁运动减弱。未发现冠状动脉夹层的迹象。鉴于急性冠状动脉综合征是由冠状动脉痉挛所致，对该患者使用氨氯地平和雷米普利进行治疗。
怀疑西布曲明的摄入诱发了冠状动脉痉挛似乎是合理的。然而，这是一种排除性诊断。此前已有三篇关于年轻患者急性心肌梗死的病例报告发表，这些患者心血管风险极低，急性心肌梗死可能与西布曲明的摄入有关。欧洲药品管理局已对西布曲明的上市许可提出质疑（2010年1月）。对于出现无法明确与心血管危险因素相关的急性冠状动脉综合征的患者，获取完整的用药史至关重要。有些患者可能仍在服用西布曲明。
