Successful Reversal of Bradycardia and Dyspnea With Aminophylline After Ticagrelor Load

A 69-year-old male underwent elective percutaneous coronary interventionrequiring placement of a drug-eluting stentto the first obtuse marginal artery. Four hours following the administration of a ticagrelor loading dose, he developed dyspnea and sinus pauses. Aminophyllinewas administered and resulted in immediate and sustained symptom resolution. Ticagrelorhas been associated with dyspnea and bradyarrhythmias, both attributed to increased adenosineexposure. Ticagrelorinhibits reuptakeof intracellular adenosine. Adenosineantagonists aminophyllineand theophyllinehave been utilized to reverse the effects of adenosineand may relieve adenosine-mediated adverse effects induced by ticagrelortherapy. Aminophyllinemay be considered for reversal of dyspnea and bradyarrhythmia associated with ticagrelortherapy through alterations in adenosineexposure.