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Acute Myocardial Infarction After Sildenafil Citrate Ingestion

Specialist, Department of Internal Medicine, Hacettepe Medicine Faculty, Ankara, Turkey

Yavuz Beyazit, MD

Specialist, Department of Internal Medicine, Hacettepe Medicine Faculty

Tugrul Purnak, MD

Research Fellow, Department of Internal Medicine, Hacettepe Medicine Faculty

Serkan Dogan, MD

Research Fellow, Department of Internal Medicine, Hacettepe Medicine Faculty

Enver Atalar, MD

Associate Professor, Department of Cardiology, Hacettepe Medicine Faculty

Reprints: Dr. Beyazit, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey, fax 90 312 305 2302, yavuzbeyaz{at}yahoo.com

OBJECTIVE: To report a case of acute myocardial infarction (MI) associated with the use of oral sildenafil in a nitrate-free patient.

CASE SUMMARY: A 45-year-old man was admitted to the hospital with acute left-sided chest pain, nausea, and vomiting that started approximately 30 minutes after taking sildenafil 100 mg before a sexual contact. The patient was diagnosed with an acute anterior MI, and therapy with aspirin, metoprolol, and unfractionated heparin was initiated. Early coronary reperfusion treatment with primary percutaneous transluminal coronary angioplasty was performed after initial evaluation. Balloon angioplasty followed by coronary stenting was performed successfully in the 80%-occluded left anterior descending artery. The patient was discharged one week after the coronary intervention without complication.

DISCUSSION: Sildenafil-associated MI is rarely seen in patients without documented coronary artery disease. By inhibiting phosphodiesterase type 5, sildenafil can cause an increase in cyclic guanosine monophosphate levels, which mediates the relaxation of vascular smooth muscle in the corpus cavernosum. Although sildenafil can cause a major decline in systemic arterial pressure in the existence of organic nitrates, physicians should be aware of its adverse cardiovascular effects even in nitrate-free patients. The Naranjo probability scale indicates that sildenafil was the possible cause of the MI.

CONCLUSIONS: Sildenafil may rarely be associated with MI in patients with no known cardiac history. Physicians should be aware of this rare and serious adverse reaction to sildenafil and counsel patients not to take sildenafil before undergoing a complete physical evaluation and further testing if warranted.

Key Words: sildenafil, myocardial infarction, nitrate-free patient

Published Online, May 24, 2005. www.theannals.com, DOI 10.1345/aph.1E665

This article has been cited by other articles:

				S. G Raja Comment: acute myocardial infarction after sildenafil citrate ingestion Ann. Pharmacother., November 1, 2005; 39(11): 1957 - 1957. [Full Text] [PDF]