Publication: Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation
used during intraoperative period have been postulated to cause temporary
spasm of the coronary vessels leading to decrease supply to the myocardium and
precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA).
As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg
epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may
be responsible for coronary vessel spasm and thus myocardial infraction in non-
obstructive coronary arteries.
We report a case of 45 years old female with papillary carcinoma of thyroid who
developed features of non-ST elevation myocardial infarction 5 minutes after the
subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine.
Patient was managed for acute Myocardial Infarction. Coronary angiogram done
the next day revealed normal coronary arteries, hence the diagnosis Myocardial
infraction in non-obstructive coronary arteries was made.
KEY WORDS
Acute myocardial infraction, Epinephrine, Local anaesthetics
Description
Koirala M,1 Shakya BM,1 Parajuli B,1 Ghimire B2
1Department of Anaesthesiology
2Department of Cardiothoracic and Vascular Anaesthesiology
Tribhuvan University Teaching Hospital
Institute of Medicine, Kathmandu, Nepal
Keywords
Acute myocardial infraction, Epinephrine, Local anaesthetics