title: Acute myocardial infarction following oral methyl-ergometrine intake.
abstract: Ergot derivatives are frequently administrated during cesarean delivery, induced abortion, or post-partum hemorrhage to promote uterine contractions. Ergot derivatives may also induce coronary spasm and intravenous ergonovine is used in cardiac catheterization laboratories as a diagnostic agent. Serious ischemic cardiac events related to ergonovine are rare and have most often been described after intravenous use. We report the case of a 38-year-old woman with a ST elevation myocardial infarction (STEMI) few days after artificially induced abortion by oral prescription of methylergometrine. Coronary angiography performed 2 days after onset of chest pain did not reveal any abnormalities of the coronary arteries but a provocative test using intravenous methylergometrine was positive with reproduction of chest pain, ECG changes and with a significant narrowing localized on the second segment of the left anterior descending artery at the angiogram. Thus, since methylergometrin may clearly induce coronary spasm when prescribed orally, chest pain occurring under oral treatment should require immediate attention even if atypical or in the absence of cardiovascular risk factors.
authors.affiliation: Service de Cardiologie, Pôle Coeur Thorax Vasculaire Hémostase, Centre Hospitalier Universitaire Trousseau, 37044, Tours, France. a.delabriolle@chu-tours.fr
authors.forename: Axel
authors.initials: A
authors.lastname: de Labriolle
authors.forename: Olivier
authors.initials: O
authors.lastname: Genée
authors.forename: Laurens Mitchell
authors.initials: LM
authors.lastname: Heggs
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
mesh_terms: D000019:Abortifacient Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000284:Administration, Oral; D000328:Adult; D000787:Angina Pectoris / Q000139:chemically induced; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008755:Methylergonovine / Q000008:administration & dosage / Q000009:adverse effects*; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000019:Abortifacient Agents; D010120:Oxytocics; D014665:Vasodilator Agents; D008755:Methylergonovine