Acute myocardial infarctiontype 2 without ST elevationfollowing administration ofbutylbromide hyoscine

Reporte de caso de un infarto agudo de miocardio sin elevación del segmento ST tipo 2, asociado a administración de butilbromuro de hioscina en una clínica de Bogotá de cuarto nivel, Colombia

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.