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首页> 外文期刊>European Heart Journal - Case Reports >Methylephedrine-induced heart failure in a habitual user of paediatric cough syrup: a case report
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Methylephedrine-induced heart failure in a habitual user of paediatric cough syrup: a case report

机译：甲基肾上腺素诱导的小儿咳嗽糖浆习惯性的心力衰竭：案例报告

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Background For relief of cold symptoms, methylephedrine is considered to be safer than ephedrine, particularly when used at the predetermined dose. It is often present in various over-the-counter (OTC) drugs for cold, including paediatric cough syrups. Case summary A 52-year-old man presented with worsening dyspnoea and anorexia for 2 weeks. He was a night shift worker and had been habitually taking large doses of methylephedrine-containing paediatric cough syrup for 20 years for sleep averting. On admission, his chest X-ray revealed pulmonary congestion and electrocardiogram showed sinus tachycardia with left-axis deviation. Echocardiography revealed diffuse hypokinesis with a reduced ejection fraction (EF) of 25%. The B-type natriuretic peptide level was elevated to 1092 ng/L. Even after treatment with low-dose dobutamine and furosemide in intensive care unit, right-heart catheterization demonstrated a ‘wet and cold’ profile. Coronary angiography revealed normal coronary arteries. Pathological examination by endomyocardial biopsy revealed cardiomyocyte hypertrophy with moderate interstitial and replacement fibrosis. In addition, cardiac magnetic resonance imaging revealed diffuse hypokinesis with mid-wall late gadolinium enhancement, which suggested fibrosis. Discontinuation of the cough syrup and optimal medical treatment with an angiotensin-converting enzyme inhibitor and a β blocker resulted in improvement in the heart failure symptoms to New York Class Association Class II. The EF also improved to 50% at 4 months after discharge. Discussion Methylephedrine is considered to have adrenergic effects; it has milder side effects on the cardiovascular system than ephedrine. However, the long-lasting excessive intake of methylephedrine, even through OTC paediatric cough syrups, has the potential to cause heart failure.
机译：背景技术为了缓解冷症状，甲羟妥碱被认为比麻黄素更安全，特别是当在预定剂量时使用。它通常存在于寒冷的各种柜台（OTC）药物中，包括儿科咳嗽糖浆。案例摘要A 52岁男子患有恶化的呼吸困难和厌食症2周。他是一个夜班员工，习惯性地服用大量含甲丙氨酸的儿科咳嗽糖浆20年来睡眠避免。在入院时，他的胸部X射线显示出肺充血和心电图显示鼻窦心动过速，左轴偏离。超声心动图显示衍射低管的衍射低管（EF）的降低25％。 B型利钠肽水平升高至1092ng /升。即使用低剂量的Dobutamine和呋塞米在重症监护病例中处理后，右心导管均表现出了“湿润和冷”型材。冠状动脉造影显示正常冠状动脉。子宫内膜活检病理学检查显示心肌细胞肥大，中间质纤维化和替代纤维化。此外，心脏磁共振成像显示弥漫性低管与中间壁晚钆增强，这提出了纤维化。用血管紧张素转换酶抑制剂和β受体阻滞的咳嗽糖浆和最佳医疗导致纽约级联级患者的心力衰竭症状改善。在出院后4个月，EF在排出后的4个月也得到了改善至50％。讨论被认为具有肾上腺素能效应;它对心血管系统具有较高的副作用而不是麻黄碱。然而，即使通过OTC儿科咳嗽糖浆，甲基苯胺的长期过度摄入量也有可能引起心力衰竭。

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