Suspected hyoscine butylbromide–induced coronary vasospasm in a young male: A case report

Hyoscine N-butylbromide (Buscopan) is frequently administered in emergency departments for abdominal pain and gastrointestinal spasm. Although generally considered safe, serious cardiovascular reactions are rarely reported. Coronary vasospasm following Buscopan administration is extremely uncommon and remains largely unrecognized in emergency medicine literature. A 29-year-old male presented with loose stools, vomiting and diffuse abdominal pain with a bloating sensation. As part of routine symptomatic management, he was administered 20 mg of intravenous Buscopan. Within minutes, he developed sudden sweating and palpitations. Electrocardiography showed transient ST-segment depression in leads II, III, aVF, and V4–V6, which resolved completely within 10 minutes. High-sensitivity troponin peaked at 750 ng/L (<22 ng/L). Echocardiography demonstrated normal cardiac function, and coronary angiography revealed normal epicardial coronaries. He was managed conservatively and discharged asymptomatic on day 3 with advice to avoid further intravenous anticholinergic agents and to use oral agents cautiously after medical review. Buscopan is routinely administered for abdominal pain, but it may rarely provoke coronary vasospasm, producing ECG changes and biomarker elevation that resemble acute coronary syndrome. Because this complication is under-recognised and poorly represented in the emergency medicine literature, clinicians may miss the association. Awareness of this possibility enables appropriate monitoring, early identification of unexpected cardiovascular reactions, and the avoidance of unnecessary interventions in otherwise low-risk patients.