Dexamethasone Associated ST Elevation Myocardial Infarction Four Days after an Unremarkable Coronary Angiogram—Another Reason for Cautious Use of Steroids: A Case Report and Review of the Literature

Table 1

Comparison between six other cases of MI associated with steroid use.

Case	Ferenchick and Adelman [14]	Yildirim et al. [15]	Arslan et al.; [16]	Takamatsu et al. [17]	Owecki and Sowiński [18]	Poorzand et al. [2]
Age (years)	37	64	20	79	66	23
Risk factors	Family history of CAD	HLD	Smoking; (7 years)	Bortezomib use	Smoking; HLD
Gender	Male	Male	Male	Female	Female	Male
Steroid type	Nandrolone-decanoate,; Boldenone,; testosterone-cypionate,; Stanozolol,; and veterinary; oxandrolone	Prednisolone	Methylprednisolone	Dexamethasone	Methylprednisolone	Dexamethasone
Indication	Anabolic steroids (weightlifting)	Idiopathic intracranial HTN; (papilledema)	Anaphylaxis	Multiple; myeloma	Graves	Anabolic steroids; (wrestling)
Route	Intramuscular & oral	Oral	Intravenous	Intravenous	Intravenous	Intramuscular
Dose	200 mg/week for 16 weeks; 1.5 cc q3 days/16 weeks; 1.5 cc q4 days/16 weeks; 1.5 cc q3 days/16 weeks; 50 mg daily for 16 weeks	40 mg; daily	40 mg	NA	1 gm daily	NA
Duration of use	Intermittent for 7 years; and then 16 weeks before the event	One month	7 minutes	5 days	5 days	6 months
Possible confounders			Hypotension secondary to anaphylaxis	Bortezomib use
Acute coronary syndrome type	STEMI	NSTEMI and then STEMI few days later	STEMI	STEMI	NSTEMI	STEMI
EKG	ST elevation,; II, III, and aVF	ST elevation, II, III, and aVF; ST depression,; I, aVL	ST elevation,; I, aVL	ST elevation,; aVR; ST depression,; I, II, and aVF; V2–6	NA	ST elevation,; I, aVL
Echo	Normal	Normal	EF 35% apical & posterolateral wall motion abnormality	EF 68%; posterior &; anterolateral akinesia	Anteroseptal akinesia	EF 35%; apical, midanterior, anteroseptal; akinesia
Left heart catheterization findings	Normal coronaries; (3 days following tissue plasminogen activator)	RCA: slow flow; and then PDA total occlusion; & LAD slow flow	Normal coronaries 10 days later; (normal IVUS); (treated with Aspirin & Heparin)	LM/LCX significant lesions LAD mod stenosis	LAD total occlusion RCA critical stenosis	Nonobstructive CAD (4 days after streptokinase)
Complications						LV thrombus