Acute myocardial infarction after use of pseudoephedrine for sinus congestion.

Coronary vasospasm has been recognized as an important factor for corollary atherogenesis and the development of symptoms associated with coronary blood flow obstruction that can lead to ischemia and eventually myocardial infarction. 1 Association of drugs and coronary artery vasospasm has been reported for such chemicals as intravenous ephedrine, cocaine, dipyridamole, trimethaphan, and sumatriptan.2-fi Few cases have been reported in which pseudoephedrine is associated with myocardial infarction. Wiener et al fi described a healthy 28-year-old man with no cardiac risk factors who had acute myocardial infarction with ST segment elevation after taking 60 mg of pseudoephedrine. Subsequent coronary angiography showed normal coronary arteries in this patient. We describe the association of anginal symptoms and eventual myocardial infarction with ingestion of an over-the-counter remedy containing pseudoephedrine.