From the FDA Drug Label
Myocardial ischemia, myocardial infarction and cardiomyopathy have been noted in the literature following overdose of epinephrine. Angina may occur in patients with coronary artery disease Arrhythmias, including fatal ventricular fibrillation, have occurred, particularly in patients with underlying organic heart disease or patients receiving drugs that sensitize the heart to arrhythmias
The risk of myocardial infarction (heart attack) with adrenaline (epinephrine) use during cardiac Magnetic Resonance Imaging (MRI) is possible, especially in patients with pre-existing coronary artery disease or underlying organic heart disease. Key factors to consider include:
- Overdose: Myocardial infarction has been noted in the literature following overdose of epinephrine 1.
- Underlying heart disease: Patients with underlying heart disease are at higher risk of adverse cardiovascular events, including angina and arrhythmias 1. It is essential to carefully weigh the benefits and risks of adrenaline use in cardiac MRI, particularly in patients with pre-existing heart conditions. 1 1
From the Research
The risk of myocardial infarction with adrenaline use during cardiac MRI is generally low, but caution is warranted in certain patient populations, as highlighted in a recent case report 2. When considering the use of adrenaline (epinephrine) during cardiac Magnetic Resonance Imaging (MRI), it is essential to weigh the potential benefits against the risks, particularly in relation to myocardial infarction (heart attack). The primary concern with adrenaline administration is its potential to increase heart rate and contractility, thereby raising oxygen demand, causing coronary vasospasm in susceptible individuals, and possibly destabilizing atherosclerotic plaques.
Key considerations for minimizing risk include:
- Using epinephrine at the lowest effective dose, typically starting at 0.1-0.5 mg/kg/min for stress testing.
- Careful monitoring of vital signs and ECG throughout administration.
- Thorough screening of patients with pre-existing coronary artery disease, uncontrolled hypertension, or arrhythmias before administration.
- Monitoring for chest pain, significant blood pressure changes, arrhythmias, and ECG abnormalities during administration.
- Ensuring emergency medications and equipment are readily available and that the procedure is performed where immediate cardiovascular support can be provided if complications arise.
Recent studies and reviews, such as those published in 3 and 4, emphasize the importance of cardiac MRI in evaluating cardiovascular diseases and the need for careful patient selection and monitoring when using adrenaline during these procedures. However, the most recent and directly relevant evidence regarding the risk of myocardial infarction with adrenaline use during cardiac MRI is found in case reports like 2, which underscores the potential for epinephrine-induced coronary vasospasm exacerbating type I myocardial infarction, particularly in patients with undiagnosed coronary artery disease.
Given the potential risks, it is crucial to approach the use of adrenaline during cardiac MRI with caution, especially in high-risk patients, and to prioritize careful monitoring and emergency preparedness. This approach aligns with the principles of minimizing morbidity, mortality, and improving quality of life, by ensuring that the benefits of the procedure outweigh the risks for each individual patient.