Rationale: Acute myocardial infarction is unusual in young persons. Drug adverse effects may be very critical and deadly.
Sildenafil is an approved first oral phosphodiesterase type-5 inhibitor pill by the Food and Drug Administration in the treatment the
erectile dysfunction. Angina, coronary vasospasm, myocardial infarctions are recorded serious cardiac presentations with sildenafil.
Acute myocardial infarction had happened post-oral tramadol in a heavy smoker. Smoking cannabis is known to be a rare acutely
trigger myocardial infarction Coronary artery spasm implicated in the pathogenesis of infarction.
Patient concerns: A 45-year-old, male patient presented to the emergency department with acute ST-segment elevation
myocardial infarction post-ingested combination of oral sildenafil tablet, oral tramadol tablet, and smoking of two hashish cigarettes
at a party.
Diagnosis: Acute ST-segment elevation myocardial infarction post-ingested combination of oral sildenafil tablet, oral tramadol
tablet, and smoking of two hashish cigarettes
Interventions: Electrocardiography, streptokinase infusion, cardiac enzymes, and later echocardiography.
Outcomes: clinical and electrocardiographic dramatic response to streptokinase infusion.
Lessons: Understanding pharmacokinetics, pharmacodynamics, drug interactions, and toxicology is essential for the clinician in
any specialty. Coronary artery spasm has often implicated suggested mechanisms in inducing acute myocardial infarction. The three
substance combinations induced myocardial infarction by either potentiating or synergism. A dramatic response for thrombolytic
therapy despite the presence of both right ventricular with inferior ST-segment elevation myocardial infarction carries a good