MYOCARDIAL-ISCHEMIA AND STUNNING INDUCED BY TOPICAL INTRANASAL PHENYLEPHRINE PLEDGETS

This case study describes myocardial ischemia and stunning after the t opical application of phenylephrine-soaked pledgets (0.25%) in a 63-ye ar-old female undergoing elective endoscopic sinus surgery. The patien t had no previous history of cardiovascular disease or illicit drug us e. Transient myocardial ischemia was associated with acute hypertensio n, chest pain, and S-T segment changes 4 minutes after pledget placeme nt. Angiography revealed normal coronary blood flow and severe left ve ntricular systolic and diastolic dysfunction, Follow-up echocardiograp hy demonstrated improved left ventricular function within 1 week and t otal resolution of dysfunction by 4 weeks after ischemia.