Ticagrelor
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Dyspnoea, bradycardia and bronchial obstruction: 2 case reports In a case report, a 59-year-old man developed strong dyspnoea and bradycardia following treatment with ticagrelor for myocardial infarction ST-elevation myocardial infarction, and a 62-year-old man developed heavy dyspnoea and bronchial obstruction following treatment with ticagrelor for non ST-elevation myocardial infarction [routes not stated; not all dosages stated]. Case report 1: A 59-year-old man, who had arterial hypertension and previous ST-elevation myocardial infarction (STEMI) treated with right coronary artery angioplasty in 2008, was hospitalised due to another STEMI. He was a former smoker. He received a loading dose of ticagrelor 180mg and underwent coronary angioplasty of left anterior descending artery and drug eluting sten implantation. Two hours following the administration of ticagrelor, he developed strong dyspnoea and anxiety. His pattern of breathing resembled Cheyne-Stokes respiration. During the episodes of bradycardia, presyncope was observed, followed by intensive sweating. The whole episode lasted about 1 to 2 minutes and then it faded as quickly as it came. He repeatedly experienced numerous attacks in every few minutes. He was afraid of further attacks. Due to recent history of acute coronary syndrome, sinus node disorders and heart failure exacerbation were suspected, but he did not have pulmonary congestion, auscultatory features of bronchial obstruction or orthopnoea. He lie down without any symptoms between the attacks, which every time ceased away without any action or sequelae. An echocardiography showed significantly reduced ejection fraction of the left ventricle. Additionally, there were no haemodynamically significant valvular defects or mechanical complication of myocardial infarction. Differential diagnosis excluded cardiac ethology of dyspnoea and finally side effect of ticagrelor was suspected. He was treated with theophylline. Shortly thereafter, the shortness of breath and the episodes of bradycardia disappeared. Two hours following the discontinuation of theophylline, the attacks returned; however, they were less intensive and without bradycardia. As a result, theophylline was resumed for 3 days and ticagrelor was switched to clopidogrel. Further hospitalisation period went without any complications. On day 5, he was discharged. Case report 2: A 62-year-old man, who was a smoker, was admitted due to non ST-elevation myocardial infarction. He received a loading dose of ticagrelor. Investigations showed significant stenosis of right coronary artery and coronary angioplasty with DES implantation was performed. Two hours following the administration of ticagrelor, he developed strong anxiety, followed by heavy dyspnoea and generalised sweating. He also showed auscultatory features of heavy bronchial obstruction and significant drop of blood oxygen saturation. He was treated with unspecified β-mimetics, unspecified cholinolytics and unspecified corticosteroids which led to a partial improvement in his clin
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