Tramadol-Induced Hypertensive Crises and Myocardial Infarction with Possible Coronary Spasm in Smoker Patient, A Case Report

Rationale: Drug adverse effects are sometimes very serious and fatal. Hypertensive emergency and acute myocardial infarction had happened post-oral tramadol in a heavy smoker. Coronary artery spasm implicated in the pathogenesis of infarction. Patient concerns: A 45-year-old, heavy-smoker male patient presented to the emergency department with acute ST-segment elevation myocardial infarction post-ingested tramadol tablet. Diagnosis: Hypertensive emergency and acute myocardial infarction Interventions: Electrocardiography, intravenous nitroglycerin infusion, streptokinase infusion, cardiac enzymes, and later echocardiography. Outcomes: clinical and electrocardiographic dramatic response to both initial intravenous nitroglycerin infusion and later streptokinase infusion. Lessons: Myocardial infarction may be initially associated with negative troponin test and absent reciprocal changes. Tramadol may be inducing-acute STsegment elevation myocardial infarction. So, how did tramadol-induced myocardial infarction and How to diagnose an infarction despite negative initial troponin test and absent reciprocal changes?