An Autopsy Case of Postpartum Acute Myocardial Infarction Associated with Postpartum Ergot Alkaloids Administration in Old-Aged Pregnant Women

Abstract

Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.

Acute Myocardial Infarction Associated With Pregnancy

“…The incidence of mortality was twice as high in women diagnosed with AMI during the peripartum period compared with the antepartum or post-partum periods (Table 1); similar findings were reported by Ladner et al (2). One case was associated with the administration of terbutaline to stop early uterine contractions during pregnancy (49), 2 cases were associated with the administration of bromocriptine to suppress post-partum lactation (52,62), and 1 case was associated with the administration of ergotamine shortly after delivery (82). Coronary angiography 2 days after an anteroseptal AMI at the end of the second trimester (A. Roth, U. Elkayam, unpublished data) resulted in extensive coronary dissection and led to both maternal and fetal death.…”

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation -A case report-

“…Although some have cardiovascular risk factors [3,4,7,8], that's not true for all patient [5,6] as in this particular patient. In fact, in survivors of sudden cardiac arrest, ergonovine test can detect coronary spasm in patients without identifiable underlying heart disease [13].…”

“…The management of the cardiac events occurred from ergonovine may be difficult, and routine cardiopulmonary resuscitation sometimes inadequate [3,4] requiring additional aggressive measures, such as intraaortic balloon pump [5,6], intracoronary nitroglycerin [6], percutaneous transluminal coronary angioplasty [7] or even extracorporeal membrane oxygenation [5]. Although her heart beat was restored with resuscitation, we needed more intervention to manage the patient.…”

“…Even some parturient might complain of chest symptoms, it usually does not progress to the myocardial ischemia [2]. Although ergonvine have been considered relatively safe and used widely in the routine obstetric practice, there are a few serious adverse events with this drug, mostly after delivery or abortion [3-8], including disastrous results [3,4]. Most of them were initially presented with cardiac abnormalities [3,4,6-8], some heralded with pulmonary sign and symptoms before a cardiac event [5], and some with cardiovascular risk factors [3,4,7,8].…”

Iatrogenic anterior myocardial infarction secondary to ergometrine-induced coronary artery spasm during dilation and curettage for an incomplete miscarriage

“…Despite its routine use in this setting, there are very few reported cases of ergometrine-induced AMI. Tragically, there have been two reported cases of AMI leading to maternal death [3,5]. Autopsy on one of these patients revealed underlying severe triple vessel coronary artery disease (CAD) [5], while the other patient, had no cardiac risk factors and normal coronary arteries on autopsy [3].…”