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Effect of simvastatin on cognitive functioning in children with neurofibromatosis type 1: a randomized controlled trial. JAMA 2008;300:287-94. KASUISTIK 1) Kardiologisk Afdeling P, Gentofte Hospital 2) Medicinsk Afdeling M, Glostrup Hospital 3) Kardiologisk-endo- krinologisk Afdeling, Hillerød Hospital Methylphenidatinduceret ST-elevations-myokardieinfarkt Martin Huth Ruwald 1 , Anne-Christine Huth Ruwald 2 & Niels Tønder 3 Antallet af patienter med diagnosen attention deficit and hyperkinetic disorder (ADHD) er stigende i Dan- mark, ligesom forbruget af methylphenidat er [1]. Methylphenidat er en centralstimulans, der via hæm- ning af monoamintransportsystemet øger niveauet af dopamin og noradrenalin i hjernen. Det anvendes primært til behandling af patienter med ADHD. I denne kasuistik beskrives et tilfælde af udbredt myokardieskade over flere indlæggelser, formentlig forårsaget af koronarspasme fremkaldt af methyl- phenidat. Koronarspasmer er en vigtig årsag til myo- kardieiskæmi, som kan føre til akut myokardiein- farkt, ventrikulære arytmier og pludselig død [2]. De patofysiologiske mekanismer, der medfører koronarspasmer, er ikke fuldt forstået. Tonus i koro- nargebetet varierer normalt via fysiologiske mekanis- mer, men graden af vasokonstriktion kan variere fra komplet okklusion til minimal sammentrækning. De anginøse smerter varierer ligeledes, men opstår, når myokardiets iltkrav overstiger tilbuddet. Kendte udløsende årsager til koronarspasmer er hyperventilation, kokain, tobak, acetylcholin, hista- min og serotonin. SYGEHISTORIE En 20-årig mand blev indlagt akut på en koronarafde- ling med tre dage varende trykkende brystsmerter uden udstråling. Et elektrokardiogram (ekg) (Figur 1) viste 1½ mm ST-elevation i II, III og AVF og tropo- nin T på 0,057 mikrogram/l stigende til 0,127 mikro- gram/l (referenceværdi < 0,030 mikrogram/l ). Ved indlæggelsen var patienten i behandling med