Document Detail

Phenelzine-induced myocardial injury: a case report.
MedLine Citation:
PMID:  20652662     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Phenelzine is an irreversible monoamine oxidase inhibitor (MAOI). Hypertensive reactions after ingestion of tyramine-rich foods such as cheese are well known. However, a review of the available medical literature found no previous reports of myocardial infarction resulting from the ingestion of cheese by a patient taking a MAOI.
CASE REPORT: A 34-year-old female taking phenelzine for depression developed severe chest pain 1 h after eating cheese. She was hypertensive and the electrocardiography showed ischemic changes in the antero-lateral chest leads. The chest pain and elevated blood pressure were relieved with intravenous morphine and nitroprusside. The initial serum troponin I level was normal, but serial repeat levels showed a rising trend with a peak at 4.89 ug/L (reference range <0.05 ug/L) 6 h after the initial blood draw, suggestive of a non-ST elevation myocardial infarction. The patient subsequently developed hypotension 4 h after another therapeutic dose of phenelzine was served to the patient 4 h after her admission to the ED. This was corrected with at least 2 L of intravenous normal saline boluses. Subsequent EKGs and Sestamibi scan showed no evidence of cardiac ischemia. She was discharged home after a hospital stay of 3 days.
DISCUSSION: We believe this to be the first reported case of myocardial infarction resulting from ingestion of cheese in a patient taking a MAOI. It might be expected that hypertensive crisis could lead to a myocardial infarction, but a review of the medical literature found no such cases reported.
Adeline Su-Yin Ngo; Raymond Y Ho; Kent R Olson
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  6     ISSN:  1937-6995     ISO Abbreviation:  J Med Toxicol     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-03     Completed Date:  2011-04-12     Revised Date:  2013-07-31    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-4     Citation Subset:  IM    
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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MeSH Terms
Cheese / adverse effects*
Chest Pain / drug therapy,  etiology,  physiopathology
Food-Drug Interactions*
Heart / drug effects,  physiopathology
Injections, Intravenous
Monoamine Oxidase Inhibitors / adverse effects*
Morphine / therapeutic use
Myocardial Infarction / blood,  chemically induced*,  physiopathology
Nitroprusside / therapeutic use
Phenelzine / adverse effects*
Treatment Outcome
Troponin I / blood
Vasodilator Agents / therapeutic use
Reg. No./Substance:
0/Monoamine Oxidase Inhibitors; 0/Troponin I; 0/Vasodilator Agents; 15078-28-1/Nitroprusside; 51-71-8/Phenelzine; 57-27-2/Morphine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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