Epinephrine-induced STEMI mimic following robotic-assisted bronchoscopy for pulmonary nodule biopsy: A two-case series

Authors

• Joshua Wortsman, Pulmonary Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
• Syed M. Naqvi, Pulmonary Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
• Jay Xiong, Pulmonary Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
• Khalid Al Efraij, Pulmonary and Critical Care Medicine, Covenant HealthCare, Saginaw, USA.
• Sushant Nanavati, Advocate Health - MidwestFollow
• Hasnain Bawaadam, Advocate Health - MidwestFollow

Recommended Citation

Wortsman J, Naqvi SM, Xiong J, Al Efraij K, Nanavati S, Bawaadam H. Epinephrine-Induced Stemi Mimic Following Robotic-Assisted Bronchoscopy for Pulmonary Nodule Biopsy: A Two-Case Series. Cureus. 2026;18(7):e112150. Published 2026 Jul 6. doi:10.7759/cureus.112150

Affiliations

Advocate Aurora Medical Center, Kenosha

Abstract

Topical endobronchial epinephrine is widely used during bronchoscopy for the management of procedure-related bleeding and is generally considered a safe and effective hemostatic agent; however, systemic absorption may rarely result in significant cardiovascular complications. We report two patients who underwent robotic-assisted bronchoscopy with transbronchial biopsy and developed acute ST-segment elevation immediately after endobronchial epinephrine was administered for post-biopsy bleeding. In both cases, electrocardiographic and telemetry findings prompted emergent cardiology evaluation and coronary angiography for suspected ST-segment elevation myocardial infarction. Coronary angiography demonstrated no obstructive coronary artery disease, and the electrocardiographic abnormalities resolved spontaneously without coronary intervention or specific treatment for myocardial ischemia. Both patients recovered without persistent cardiovascular sequelae during the remainder of their hospitalization. The close temporal relationship between epinephrine administration and ischemic electrocardiographic changes, combined with normal coronary angiography, suggests that transient coronary vasospasm was the presumed mechanism, although other causes of transient ST-segment elevation cannot be completely excluded. Although uncommon, this complication has important implications as advanced bronchoscopic procedures increasingly rely on transbronchial sampling techniques that may require topical hemostatic agents. Phenylephrine represents a potentially safer alternative hemostatic agent because it provides local vasoconstriction without β-adrenergic stimulation, which may reduce the risk of arrhythmogenic and ischemic cardiovascular effects. Bronchoscopists should remain vigilant for cardiovascular complications following airway epinephrine administration, particularly in patients with underlying cardiovascular risk factors. Further studies are needed to compare the safety and efficacy of topical epinephrine and phenylephrine in the bronchoscopic setting.

Document Type

Article

PubMed ID

42559445