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Acute myocardial infarction during regadenoson myocardial perfusion imaging.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Shah, Sachil Parra, David Rosenstein, Robert S.
Description	Country affiliation: United States Author Affiliation: Shah S ( Internal Medicine Residency Program, University of Miami School of Medicine Regional Campus, Atlantis, Florida 33462, USA. sshah7@med.miami.edu)
Abstract	Pharmacologic stress testing uses vasodilators to provide objective evidence of myocardial ischemia. Adenosine and dipyridamole are nonselective adenosine receptor agonists that have been associated with myocardial infarction (MI) during intravenous infusion. Mechanisms postulated for this effect include coronary steal, transmural steal, global hypotension, and direct vasoconstriction. Regadenoson, a direct A2A agonist, was approved for use in stress testing in 2008. We describe a 68-year-old man who presented to our institution with typical angina, relieved by nitroglycerin. He did not have electrocardiogram (ECG) changes suggestive of myocardial pathology, and laboratory testing did not reveal a significant rise in troponin-I levels. To further assess the etiology of his symptoms, he underwent a pharmacologic stress test with regadenoson followed by technetium 99 m sestamibi. Six minutes after regadenoson infusion, the patient developed severe retrosternal chest pain accompanied by ST elevations on ECG. Sublingual nitroglycerin was administered that resolved both the pain and ECG changes. The patient subsequently underwent urgent coronary angiography and was found to have a 95% critical stenosis involving the left anterior descending artery. We conclude this case represents a MI secondary to coronary steal phenomenon induced by regadenoson infusion. Clinicians should be aware this adverse effect can occur despite the improved side-effect profile of regadenoson. Continuous monitoring of vital signs and the ECG with regular assessment of symptoms is imperative to identify this rare but potentially devastating adverse event.
File Format	HTM / HTML
ISSN	02770008
Issue Number	6
Volume Number	33
e-ISSN	18759114
Journal	Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2013-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Adenosine A2 Receptor Agonists Adverse Effects Myocardial Infarction Etiology Myocardial Perfusion Imaging Methods Purines Pyrazoles Aged Coronary Circulation Drug Effects Electrocardiography Exercise Test Humans Male Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Pharmacology (medical)

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