Acute myocardial infarction due to coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case report

Area of Science:

• Cardiology
• Occupational Health

Background:

• Industrial nitroglycerin exposure is common in explosives manufacturing.
• Sudden cessation of nitroglycerin can lead to withdrawal symptoms.

Observation:

• A 45-year-old Black male, employed in an explosives factory, presented with acute transmural anterior myocardial infarction.
• Coronary angiography showed normal coronary arteries.
• Ergonovine provocation test did not induce coronary vasospasm.

Findings:

• The myocardial infarction is postulated to be directly caused by coronary vasospasm.
• This vasospasm is hypothesized to be a result of the 'industrial nitroglycerin withdrawal syndrome'.
• No other etiological factors for the infarction were identified.

Implications:

• This case highlights a potential occupational health risk associated with industrial nitroglycerin.
• It suggests coronary vasospasm due to nitroglycerin withdrawal can precipitate myocardial infarction even in the absence of atherosclerosis.
• This is the first reported case of this phenomenon in a Black individual.