Abstract
Introduction
Phenelzine is an irreversible monoamine oxidase inhibitor (MAOI). Hypertensive reactions after ingestion of tyramine-rich foods such as cheese are well known. However, a review of the available medical literature found no previous reports of myocardial infarction resulting from the ingestion of cheese by a patient taking a MAOI.
Case Report
A 34-year-old female taking phenelzine for depression developed severe chest pain 1 h after eating cheese. She was hypertensive and the electrocardiography showed ischemic changes in the antero-lateral chest leads. The chest pain and elevated blood pressure were relieved with intravenous morphine and nitroprusside. The initial serum troponin I level was normal, but serial repeat levels showed a rising trend with a peak at 4.89 ug/L (reference range <0.05 ug/L) 6 h after the initial blood draw, suggestive of a non-ST elevation myocardial infarction. The patient subsequently developed hypotension 4 h after another therapeutic dose of phenelzine was served to the patient 4 h after her admission to the ED. This was corrected with at least 2 L of intravenous normal saline boluses. Subsequent EKGs and Sestamibi scan showed no evidence of cardiac ischemia. She was discharged home after a hospital stay of 3 days.
Discussion
We believe this to be the first reported case of myocardial infarction resulting from ingestion of cheese in a patient taking a MAOI. It might be expected that hypertensive crisis could lead to a myocardial infarction, but a review of the medical literature found no such cases reported.
Keywords: Nardil®, Monoamine oxidase inhibitor, Myocardial infarction
Full Text
The Full Text of this article is available as a PDF (379.0 KB).
Acknowledgments
Funding
There is no funding for this project.
Conflicts of interest
There are no known conflicts of interest.
References
- 1.Linden CH, Rumach BH, Strehilke C. Monoamine oxidase inhibitor overdose. Ann Emerg Med. 1984;13:1137–1144. doi: 10.1016/s0196-0644(84)80339-x. [DOI] [PubMed] [Google Scholar]
- 2.Smookler S, Bermudez AJ. Hypertensive crisis resulting from an MAO inhibitor and an over-the-counter appetite suppressant. Annals of Emerg Med. 1982;11(9):482–484. doi: 10.1016/s0196-0644(82)80067-x. [DOI] [PubMed] [Google Scholar]
- 3.Lee WC, Shin YH, Shideman FE. Cardiac activities of several monoamine oxidase inhibitors. J Pharmacol Exp Ther. 1961;133:180–185. [PubMed] [Google Scholar]
- 4.D'Mello A. Interaction between phenylpropanolamine and monoamine oxidase inhibitors. J Pharm Pharmacol. 1968;21:577–580. doi: 10.1111/j.2042-7158.1969.tb08322.x. [DOI] [PubMed] [Google Scholar]
- 5.Kokan L, Benowitz NL (2007) Monoamine oxidase inhibitors. In KR Olson (Ed.) Poisoning and drug overdose, 5th edn. (pp. 269–272). International edition: McGraw-Hill Lange
- 6.Marley E, Blackwell B. Interactions of monoamine oxidase inhibitors, amines, and foodstuffs. Adv Pharm Chemother. 1970;7:185–239. doi: 10.1016/s1054-3589(08)60597-9. [DOI] [PubMed] [Google Scholar]
- 7.Horowitz D, Lovenberg W, Engelman K. Monoamine-oxidase inhibitors, tyramine and cheese. JAMA. 1964;188:118. doi: 10.1001/jama.1964.03060390010002. [DOI] [PubMed] [Google Scholar]
- 8.Blackwell B. Hypertensive crisis due to monoamine oxidase inhibitors. Lancet. 1963;2:849. doi: 10.1016/s0140-6736(63)92743-0. [DOI] [PubMed] [Google Scholar]
- 9.Kokan L (2002) Monoamine oxidase inhibitors. In LR Goldfrank, NE Flomenbaum, NA Lewin, MA Howland, RS Hoffmann, LS Nelson (Eds.) Goldfrank’s toxicologic emergencies, 7th edn (pp 890). Medical Publishing Division, International: McGraw-Hill
- 10.Keck PE, Vuckovic A, Pope HG, Nierenberg AA, Gribble GW, White K.Acute cardiovascular response to monoamine oxidase inhibitors: a prospective assessment J Clin Psychopharmacol 198993203–206.10.1097/00004714-198906000-00008 [PubMed] [Google Scholar]
- 11.Linet LS. Mysterious MAOI hypertensive episodes. J Clin Psychiatry. 1986;47:563–565. [PubMed] [Google Scholar]
- 12.Fallon B, Fotoe B, Walsh BT, Roose SP. Spontaneous hypertensive episodes with MAOI. J Clin Psychiatry. 1988;49:162–165. [PubMed] [Google Scholar]
- 13.Golwyn DH, Sevlie CP. Monoamine oxidase inhibitor hypertensive crisis headache and orthostatic hypotension. J Clin Psychopharmacol. 1993;13(1):77–78. doi: 10.1097/00004714-199302000-00014. [DOI] [PubMed] [Google Scholar]
- 14.De Villiers JC. Intracranial haemorrhage in patients treated with monoamineoxidase inhibitors. Br J Psychiatry. 1966;112(483):109–118. doi: 10.1192/bjp.112.483.109. [DOI] [PubMed] [Google Scholar]
- 15.Bethune HC, Burrell RH, Culpan H, Ogg GJ. Vascular crisis associated with monoamine-oxidase inhibitors. Am J Psychiatry. 1964;121:245–248. doi: 10.1176/ajp.121.3.245. [DOI] [PubMed] [Google Scholar]
- 16.Kearney TE (2007) Nitroprusside. In KR Olson (Ed.) Poisoning and drug overdose, 5th edn. (pp. 485–487). International edition: McGraw-Hill Lange
- 17.Gessa GL, Cuenca E, Costa E. On the mechanism of hypotensive effects of MAO inhibitors. Ann N Y Acad Sci. 1963;8(107):935–944. doi: 10.1111/j.1749-6632.1963.tb13336.x. [DOI] [PubMed] [Google Scholar]
- 18.Frieden J. Propanolol as an antiarrythmic agent. Am Heart J. 1967;74:283–285. doi: 10.1016/0002-8703(67)90291-8. [DOI] [PubMed] [Google Scholar]
- 19.Lotufo-Neto F, Trivedi, Thase ME. Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology. 1999;20(3):226–247. doi: 10.1016/S0893-133X(98)00075-X. [DOI] [PubMed] [Google Scholar]