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TRAZODONE INDUCED VASOSPASTIC ANGINA MIMICKING WITH ST- ELEVATION MYOCARDIAL INFARCTION

A. Ruhela1, Y.R. Sedhai1, J. Janani1, N. Kumar1, E. Mizrahi2

1. Mercy Catholic Medical Center, Darby, PA, USA

2. Mercy Philadelphia Hospital, Philadelphia, PA, USA

Objectives: To report rare association of trazodone intoxication with coronary vasospasm and ST segment elevation.

Introduction: Vasospastic angina is a syndrome of chest pain caused by myocardial ischemia secondary to reversible coronary artery vasospasm. It is characterized by transient elevation of ST-segment in presence of angiographically normal coronary arteries. Although tricyclic antidepressants and antipsychotics have been previously associated with coronary vasospasm , trazodone’s association has not been previously reported.

Case Presentation: We present a case of a 29-year-old Caucasian male who presented to the emergency after suicidal ingestion of 25 tablets of Trazodone 50 mg. His initial electrocardiography revealed 3 mm ST-segment elevation in leads II, III and aVF along with reciprocal ST-segment depression in anterior wall leads. He was immediately taken to cardiac catheterization laboratory on account of acute infero-posterior wall ST-segment elevation myocardial infarction. Coronary angiography revealed normal epicardial coronary arteries. His subsequent electrocardiograms showed resolution of ST segment changes. He was treated with vasodilator therapy using topical nitroglycerin paste along with supportive measures. He had an uneventful cardiovascular recovery and antidepressant regimen was changed to Mirtazapine.

Conclusion: Trazodone is a serotonin antagonist and reuptake inhibitor and is regarded as the least cardiotoxic antidepressant. QT prolongation and risk of ventricular arrhythmias are well known cardiac side effects of tricyclic antidepressant and selective serotonin reuptake inhibitors. Increased serotonergic effect of Trazodone at toxic levels may be a possible cause of coronary vasospasm.

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