Myocardial infarction in non-obstructive coronary artery (MINOCA) in a young girl with multidrug poisoning

Abstract

A 24-year-old girl was admitted to the emergency room with chest pain, abdominal discomfort and excessive sleeping tendency after taking some unprescribed medications. She had no risk factors for cardiovascular disease. On query, she gives a history of taking multiple medications available in her room due to some emotional outbreak. Her relatives give a history of taking paracetamol 1000 mg, cephradine 2500 mg, propranolol 100 mg, bilastine 160 mg and hydroxyzine 200 mg. None of these drugs have proven to cause myocardial infarction (MI) at this dosage. Initial ECG showed sinus bradycardia which can be because of taking propranolol. But 2 hours after admission, she developed severe chest pain and at that time ECG showed gross segment (ST) depression. Troponin-i was found to be raised. After initial management, a coronary angiogram was done which revealed normal epicardial coronaries. Patient was managed symptomatically and she recovered completely.