Tramadol-Induced Myocardial Infarction, Hypertensive Pulmonary Edema, Wavy Triple Sign (Yasser’s Sign), Ventricular Fibrillation, And Death with Possible Serotonin Syndrome in a Heavy Smoker

Elsayed YMH

Published on: 2024-11-05

Abstract

Rationale: Drug side effects may be very critical and deadly. Undoubtedly, acute myocardial infarction, hypertensive crises, and pulmonary edema are serious adverse effects. Tramadol is a known opioid analgesic for both moderate and severe pain in primary care. Cigarette smoking is a traditional strong risk factor for cardiovascular diseases. Serotonin syndrome and coronary artery spasms are embroiled in the pathogenesis of myocardial infarction, hypertensive crises, and pulmonary edema after tramadol. The Wavy triple electrocardiographic sign (Yasser’s sign) is an innovative diagnostic sign in hypocalcemia. Patient concerns: A 53-year-old, Carpenter male patient presented to the emergency department with acute myocardial infarction, hypertensive crises, pulmonary edema, and serotonin syndrome after an overdose of oral tramadol. Diagnosis: Tramadol inducing acute anteroseptal myocardial infarction, hypertensive crises, pulmonary edema, Wavy triple sign (Yasser’s sign), and serotonin syndrome. Interventions: Electrocardiography, oxygenation, and streptokinase intravenous infusion. Outcomes: Clinical retro-gradation terminating with sudden death. Lessons: The association of overdose of oral tramadol with acute myocardial infarction, hypertensive crises, pulmonary edema, and the Wavy triple sign (Yasser’s sign) is tremendous. Tramadol overdose may be lethal. The constellation of acute anteroseptal myocardial infarction, hypertensive crises, pulmonary edema, ECG sinus tachycardia, hypoxia, and Wavy triple sign (Yasser’s sign) of hypocalcemia, cigarette smoking may carry poor prognostic factors and progress step for sudden cardiac death. The priority of management for any physician should be directed to identifying the etiology and knowing the drug's adverse effects.