Acute myocardial infarction after a local anesthetic procedure in a middle-aged patient

We report a case of acute myocardial infarction (AMI) occurring after a local injection of lidocaine. The patient presented with symptoms of myocardial ischemia, dynamic changes in the ST segment of the electrocardiogram, and significantly elevated levels of cardiac troponin; however, coronary angiography findings were normal. According to the clinical definition of AMI, these features indicated the presence of acute myocardial injury, reflected by abnormal cardiac biomarkers and supported by evidence of acute myocardial ischemia. Coronary artery spasm is an important cause of AMI and can be induced by drug effects. Lidocaine is a local anesthetic and antiarrhythmic drug widely used in clinics. The potential mechanism in this case may be lidocaine-induced coronary artery spasm. The possible serious side effects of lidocaine require the attention and vigilance of clinicians. To our knowledge, this is the first report to describe coronary artery spasm possibly induced directly by lidocaine.

Automated summary

We report a case of acute myocardial infarction (AMI) occurring after a local injection of lidocaine. The patient presented with symptoms of myocardial ischemia, dynamic changes in the ST segment of the electrocardiogram, and significantly elevated levels of cardiac troponin; however, coronary angiography findings were normal. The possible mechanism in this case may be lidocaine-induced coronary artery spasm. The potential serious side effects of lidocaine require the attention and vigilance of clinicians.