Non-ST Elevation Myocardial Infarction Induced by Sildenafil Consumption in a Patient with No Coronary Artery Disease History: A Case Report
Author : I.M.E.A. Wardhana, P.G. Budiana*
Upload Date : 19-04-2018
Background: Sildenafil citrate, which works effectively in the treatment of male erectile dysfunction, in some literatures revealed a number of serious cardiovascular events, including myocardial infarction (MI).
Objective: To present a case with Non ST Elevation Myocardial Infarction induced by sildenafil consumption with no coronary artery disease (CAD) history.
Case Illustration: A 52-years-old male patient presented to RSUD Badung Mangusada emergency department with chest pain for 1 hour after taking herbal medicine that contain Viagra (sildenafil citrate) before any attempted sexual activity. He has uncontrolled hypertension and smoking 4 boxes a day. No history of other systemic disease. The patient's vital sign is normal. Initial electrocardiogram showed T inversion over lead III and aVF and there was an increase level of CKMB (71,2 ng/mL) and hs Troponin I (7544,5 ng/L). The patient was diagnosed with NSTEMI. The patient underwent a coronary angiography and it showed stenosis (90%) at proximal until mid RCA, subtotal stenosis after RV branch, and total stenosis before PDA; stenosis after D1 unti D2 branch of LAD (60%); stenosis after OM1 (80%) and subtotal stenosis after OM3 of LCx.
Discussion: There is a growing body of evidence demonstrating that sildenafil use is not associated with an increased risk for cardiovascular events but patients with known CAD using nitrates are more at risk of developing MI after receiving sildenafil from so called coronary steal phenomenon. Recent studies indicate that erectile dysfunction is a harbinger of CAD, as atherosclerosis affects both coronary and penile vasculature. On the contrary, sildenafil-associated MI is rarely seen in patients without previous history of coronary artery disease (CAD) as happen to our patient. Li et al showed that sildenafil, a cGMP-enhancing agent, promoted von Willebrand Factor or thrombin-induced platelet aggregation.
Conclusion: This report shows a rare sildenafil-associated myocardial infarction in a patient without previous history of CAD. Further studies and data are needed to prove the association between sildenafil intake and acute coronary syndrome.
KEYWORDS : NSTEMI, Myocardial Infarction, Sildenafil
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