Myocardial Infarction and Dynamic Left Ventricular Outflow Obstruction Induced by Bronchodilator Therapy

Abstract

Objective:

To report a case of myocardial infarction with patent coronary arteries and left ventricular outflow obstruction induced by a combination of aminophylline and beta₂-agonists treatment.

Case Summary:

A 61-year-old woman, without risk factors for coronary artery disease, was admitted with an exacerbation of bronchial asthma. She received intravenous aminophylline and aerosolized beta₂-agonists. She developed hemodynamic and echocardiographic features of obstructive hypertrophic cardiomyopathy and had a myocardial infarction. Her serum theophylline concentration was normal. At cardiac catheterization the coronary arteries were patent and the obstructive features disappeared when the asthma drug treatment was discontinued.

Discussion:

This case describes the occurrence of a very unusual combination of cardiovascular adverse effects induced by drugs widely used for treatment of bronchial asthma. Aminophylline and beta₂-agonists can cause myocardial ischemia by inducing tachycardia, hypercontractility, and coronary artery spasm.

Conclusions:

Aminophylline and beta₂-agonists can induce severe and life-threatening myocardial ischemia, even when used at therapeutic drug concentrations.