Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest
  • Parminder Kaur
    Department of Cardiology, Saint Joseph's University Medical Center, Paterson, NJ, USA
  • Melvin Santana
    Department of Internal Medicine Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Balraj Singh
    Department of Hematology-Oncology, Saint Joseph's University Medical Center, Paterson, NJ, USA https://orcid.org/0000-0001-7986-6031
  • Anuraag Sah
    Department of Internal Medicine Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Raja Pullatt
    Department of Cardiology, Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Fayez Shamoon
    Department of Cardiology, Saint Joseph's University Medical Center, Paterson, NJ, USA

Keywords

Misoprostol, Takotsubo cardiomyopathy, coronary vasospasm

Abstract

Misoprostol is a synthetic E1 prostaglandin commonly used to induce abortion in the United States and elsewhere. There is limited literature on the cardiovascular adverse effects of misoprostol, and, to the best of our knowledge, very few such events have been reported. We describe the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and experienced a cardiac arrest due to coronary vasospasm. She was successfully resuscitated and echocardiography showed features consistent with Takotsubo cardiomyopathy. Coronary angiography revealed coronary artery spasm which responded to nitroglycerin. Our case adds to the limited literature on this life-threatening adverse event of misoprostol.

VIEW THE ENTIRE ARTICLE

References

  • Tang OS, Gemzell-Danielson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on uterus and side-effects. Int J Gynecol Obstet 2007;99:160–167. doi: 10.1016/j.ijgo.2007.09.004
  • Prashanth A, Chakravarthy M, Maddirala P. Life threatening adverse reaction following prostaglandin analogue use in obstetric and gynecological practice. J Obstet Anesth Crit Care 2016;6:34–37. doi: 10.4103/2249-4472.181077
  • Illa M, Bennasar M, Eixarch E, Berge R, Font C, Palacio M. Acute coronary artery vasospasm associated with misoprostol for termination of pregnancy. Fetal Diagn Ther 2010;27:174–177. doi: 10.1159/000295923
  • Owusu KA, Brennan J, Perelman A, Meoli E, Altshuler J. Nitroglycerin administration during cardiac arrest by coronary vasospasm secondary to misoprostol. J Cardiol Cases 2015;12(5):166–168. doi: 10.1016/j.jccase.2015.07.003.
  • Mazhar F, Sultana J, Akram S. Misoprostol-induced acute coronary syndrome in a premenopausal woman: a case report with literature review. Curr Drug Saf 2018;13(1):65–68. doi: 10.2174/1574886312666171122100929
  • Sung CW, Jung JH, Lee SH, Lee KM, Ahn BM, Choi S, et al. Acute myocardial infarction due to vasospasm induced by prostaglandin. Can J Cardiol 2009;25(10):e359–360. doi: 10.1016/s0828-282x(09)70724-x
  • Qian YM, Jones RL, Chan KM, Stock AI, Ho JK. Potent contractile actions of prostanoid EP3-receptor agonists on human isolated pulmonary artery. Br J Pharmacol 1994;113(2):369–374. doi: 10.1111/j.1476-5381.1994.tb16997
  • Brennan A, Adams H, Galligan J, Whitbourn R. Coronary vasospasm and concurrent Takotsubo cardiomyopathy. Br J Cardiol 2019;26:38–50. doi: 10.5837/bjc.2019.011
  • Misumi I, Ebihara K, Akahoshi R, Hirota Y, Sakai A, Sanjo M, et al. Coronary spasm as a cause of Takotsubo cardiomyopathy and intraventricular obstruction. J Cardiol Cases 2010;2(2):e83–87. doi: 10.1016/j.jccase.2010.03.007
  • Views: 810
    HTML downloads: 415
    PDF downloads: 393


    Published: 2021-06-23
    Issue: 2021: Vol 8 No 6 (view)


    How to cite:
    1.
    Kaur P, Santana M, Singh B, Sah A, Pullatt R, Shamoon F. Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest. EJCRIM 2021;8 doi:10.12890/2021_002674.

    Similar Articles

    You may also start an advanced similarity search for this article.

    Most read articles by the same author(s)