Acute myocardial infarction type 2 without ST elevation following administration of butylbromide hyoscine.
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| Title: | Acute myocardial infarction type 2 without ST elevation following administration of butylbromide hyoscine. |
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| Alternate Title: | Infarto Agudo de Miocardio Tipo 2 sin Elevación del ST tras administración de butilbromuro de hioscina: reporte de caso. Infarto agudo do miocárdio tipo 2 sem elevação do ST após administração de brometo de butil-hioscina: relato de caso. |
| Authors: | Nossa Ávila, Samuel Eduardo1, Franco González, Sebastián2, Gómez Muñoz, Karen Daniela3, Camargo Salas, Carlos Fernando4 cfcs05@hotmail.com |
| Source: | Archivos de Medicina (1657-320X). ene-jun2026, Vol. 26 Issue 1, p1-7. 7p. |
| Subjects: | Non-ST elevated myocardial infarction, Antispasmodics, Hemodynamics, Atrial fibrillation, Coronary angiography, Myocardial infarction, Major adverse cardiovascular events, Chest pain |
| Abstract (English): | We report the case of a woman in her eighth decade who developed atrial fibrillation and a type 2 non–ST-elevation myocardial infarction (type 2 NSTEMI) after intravenous administration of 20 mg hyoscine butylbromide as premedication for colonoscopy. Coronary angiography showed no obstructive lesions. Main findings: Onset was sudden, 2 minutes after administration of hyoscine butylbromide, with oppressive retrosternal chest pain radiating to the jaw, dyspnea, diaphoresis and palpitations. Physical examination revealed marked hypotension and tachycardia. Electrocardiogram demonstrated new-onset atrial fibrillation without ischemic ST-T changes. High-sensitivity troponin T was significantly elevated and transthoracic echocardiography showed segmental wall-motion abnormalities of the basal anterolateral wall. Diagnosis, interventions and outcome: A diagnosis of type 2 NSTEMI secondary to unstable atrial fibrillation with rapid ventricular response-likely triggered by an adverse reaction to hyoscine butylbromide-was made. The patient underwent coronary catheterization without evidence of coronary stenosis. Management included hemodynamic support with intravenous fluids, beta-blocker therapy, statin therapy, initial antiplatelet therapy and anticoagulation. She had a favorable clinical course and was discharged on a beta-blocker and oral anticoagulation. Conclusions: • Acute myocardial infarction may result from mechanisms other than atherosclerotic coronary obstruction, notably supply–demand mismatch. • Hyoscine butylbromide, although commonly associated with xerostomia, constipation and nausea, can be associated with serious cardiovascular adverse events that require prompt recognition and management. • Retrosternal chest pain requires a broad differential diagnosis (including pulmonary embolism and acute coronary syndromes); an accurate and timely diagnostic approach is essential. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Se presenta el caso de una mujer en la octava década de la vida que desarrollo episodio de fibrilación auricular e infarto agudo de miocardio sin elevación del ST (IAMSEST) tipo 2 tras la administración intravenosa de 20 mg de butilbromuro de hioscina como premedicacion para colonoscopia sin hallazgos en la arteriografía coronaria. Hallazgos principales: Fue de inicio subito 2 minutos posteriores a la aplicación del butil bromuro hioscina iniciado como un dolor torácico retroesternal opresivo irradiado a mandíbula, disnea, diaforesis y palpitaciones. Al examen físico con hipotensión marcada y taquicardia. A los paraclínicos con evidencia de un electrocardiograma con fibrilación auricular de novo, no signos de isquemia. Troponina T ultrasensible con aumento significativo y ecocardiograma con trastornos segmentarios de la contractilidad basal anterolateral. Diagnósticos, intervenciones y resultados: Se considero un IAMSEST tipo 2 secundario a una fibrilación auricular con respuesta ventricular rápida inestable, secundario a una reacción adversa al butilbromuro de hioscina. Fue llevada a cateterismo coronario sin evidencia de estenosis coronaria por lo que se consideró manejo con líquidos endovenosos, betabloqueo, estatina, antiagregación inicial y anticoagulación. Adicionalmente por los hallazgos y la evolución favorable egreso con betabloqueador y anticoagulación oral. conclusión: • El infarto agudo de miocardio es una condición clínica que puede ser ocasionada por causas diferentes a la enfermedad coronaria, como cambios en la oferta y demanda de oxígeno miocárdico. • El butilbromuro de hioscina tiene efectos adversos que son más frecuentes como lo pueden ser xerostomía, constipación y nauseas, sin embargo, los efectos adversos cardiovasculares pueden ser presentados y tienen que ser manejados de manera adecuada. El dolor torácico retroesternal es un síntoma que puede ser atribuido a diferentes causas como lo es el tromboembolismo pulmonar o el infarto agudo de miocardio, a razón de esto es esencial el manejo y enfoque diagnostico acertado. [ABSTRACT FROM AUTHOR] |
| Abstract (Portuguese): | Relatamos o caso de uma mulher na oitava década de vida que desenvolveu fibrilação atrial e infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) tipo 2, após administração intravenosa de 20 mg de butilbrometo de hioscina como premedicação para colonoscopia. A angiografia coronária não revelou lesões obstrutivas. Achados principais: O início foi súbito, 2 minutos após a administração do butilbrometo de hioscina, manifestando-se por dor torácica retroesternal opressiva irradiada à mandíbula, dispneia, diaforese e palpitações. Ao exame físico havia hipotensão marcada e taquicardia. O eletrocardiograma evidenciou fibrilação atrial de novo sem alterações isquêmicas de ST–T. A troponina T de alta sensibilidade apresentou elevação significativa e o ecocardiograma transtorácico mostrou alterações segmentares do movimento parietal na região basal anterolateral. Diagnóstico, intervenções e evolução: Foi estabelecido diagnóstico de IAMSSST tipo 2 secundário a fibrilação atrial com resposta ventricular rápida instável, provavelmente desencadeada por reação adversa ao butilbrometo de hioscina. A paciente foi submetida a cateterismo coronário sem evidência de estenose coronária. A conduta incluiu suporte hemodinâmico com reposição volêmica endovenosa, betabloqueador, estatina, terapia antiplaquetária inicial e anticoagulação. Evoluiu favoravelmente e recebeu alta com betabloqueador e anticoagulação oral. Conclusões: • Infarto agudo do miocárdio pode decorrer de mecanismos distintos da doença aterosclerótica coronariana, como desequilíbrio entre oferta e demanda de oxigênio miocárdico. • Butilbrometo de hioscina, embora frequentemente associado a efeitos adversos como xerostomia, constipação e náuseas, pode provocar eventos cardiovasculares graves que exigem reconhecimento e manejo imediato. • A dor torácica retroesternal possui um amplo diagnóstico diferencial (incluindo tromboembolismo pulmonar e síndromes coronarianas agudas); portanto, uma abordagem diagnóstica rápida e precisa é essencial. [ABSTRACT FROM AUTHOR] |
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| Database: | MedicLatina |
| Abstract: | We report the case of a woman in her eighth decade who developed atrial fibrillation and a type 2 non–ST-elevation myocardial infarction (type 2 NSTEMI) after intravenous administration of 20 mg hyoscine butylbromide as premedication for colonoscopy. Coronary angiography showed no obstructive lesions. Main findings: Onset was sudden, 2 minutes after administration of hyoscine butylbromide, with oppressive retrosternal chest pain radiating to the jaw, dyspnea, diaphoresis and palpitations. Physical examination revealed marked hypotension and tachycardia. Electrocardiogram demonstrated new-onset atrial fibrillation without ischemic ST-T changes. High-sensitivity troponin T was significantly elevated and transthoracic echocardiography showed segmental wall-motion abnormalities of the basal anterolateral wall. Diagnosis, interventions and outcome: A diagnosis of type 2 NSTEMI secondary to unstable atrial fibrillation with rapid ventricular response-likely triggered by an adverse reaction to hyoscine butylbromide-was made. The patient underwent coronary catheterization without evidence of coronary stenosis. Management included hemodynamic support with intravenous fluids, beta-blocker therapy, statin therapy, initial antiplatelet therapy and anticoagulation. She had a favorable clinical course and was discharged on a beta-blocker and oral anticoagulation. Conclusions: • Acute myocardial infarction may result from mechanisms other than atherosclerotic coronary obstruction, notably supply–demand mismatch. • Hyoscine butylbromide, although commonly associated with xerostomia, constipation and nausea, can be associated with serious cardiovascular adverse events that require prompt recognition and management. • Retrosternal chest pain requires a broad differential diagnosis (including pulmonary embolism and acute coronary syndromes); an accurate and timely diagnostic approach is essential. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 1657320X |
| DOI: | 10.30554/archmed.26.1.5465.2026%20 |
