Acute myocardial infarction and cardiac arrest induced by oxymetazoline nasal spray overdose: a case report

Abstract Background Oxymetazoline nasal spray is a widely used over-the-counter sympathomimetic decongestant. While generally safe at therapeutic doses, overdose can result in systemic vasoconstriction and potentially life-threatening cardiovascular complications. Case summary We report the case of a previously healthy 27-year-old man who presented after an out-of-hospital cardiac arrest following excessive use of oxymetazoline nasal spray. He was found in ventricular fibrillation and required cardiopulmonary resuscitation and defibrillation. Post-resuscitation electrocardiogram showed transient ST-segment elevations, and cardiac biomarkers were markedly elevated. However, emergent coronary angiography revealed normal coronary arteries. Comprehensive cardiac evaluation, including cardiac magnetic resonance imaging and electrophysiologic studies, excluded myocardial infarction, myocarditis, myocardial fibrosis, and Brugada syndrome. The patient experienced prolonged neurological recovery but improved with rehabilitation. Discussion Oxymetazoline overdose should be considered a potential cause of acute coronary syndrome, malignant arrhythmias, and cardiac arrest, even in young individuals without pre-existing cardiovascular disease. Clinician awareness and patient education on the safe use of sympathomimetic agents are essential for prevention.