Coronary artery vasospasm after misoprostol treatment for incomplete abortion: a case report

Muñoz-Franco, Francisca María; Lacunza, Javier; Andrés, David José Vázquez; Rodríguez-Hernández, José Ramón

doi:10.1016/j.contraception.2019.08.003

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…11,12 The most common adverse effects of misoprostol are gastrointestinal, whereas cardiovascular effects rarely occur. 2 Most of previous studies found no adverse cardiovascular effects following the use of misoprostol. [13][14][15][16] However, some studies reported cardiovascular effects related to misoprostol.…”

Section: Discussionmentioning

confidence: 92%

“…To achieve this aim, traditional surgical evacuation had been done in the past, however, nowadays, non-surgical approaches such as medical treatments with prostaglandin analogs for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. 2 Misoprostol is a prostaglandin E1 (PGE1) analog that is mostly used for the prevention and treatment of peptic ulcers. 3 Furthermore, the use of Misoprostol for labor induction is also approved in many countries because of its affordability, molecular stability, ease of administration, and clinical efficacy.…”

Section: Introductionmentioning

confidence: 99%

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Reactions to Misoprostol: A Case Report

Salari,

Pourrajabi,

Karami

et al. 2023

Clin Med Insights Case Rep

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Background: Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects. Case Presentation: A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O2 saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient’s blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O2 saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn’t successful and she died. Conclusions: In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Reactions to Misoprostol: A Case Report

Salari,

Pourrajabi,

Karami

et al. 2023

Clin Med Insights Case Rep

View full text Add to dashboard Cite

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“…Moreover, typical precipitating factors for this condition include cold exposure, mental stress, stimulants, and medications, such as sympathomimetics and vasoconstrictor agents (10,11). The cardiovascular events or adverse effects of misoprostol were summarized in Table 1 (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

A case report and literature review of myocardial infarction with nonobstructive coronary arteries (MINOCA) possibly due to acute coronary vasospasm induced by misoprostol

Hau,

Han,

Minh

et al. 2023

Front. Cardiovasc. Med.

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Coronary artery vasospasm (CVS), an uncommon cause of acute chest pain, can be provoked by vasoconstriction-induced medications. Misoprostol, a prostaglandin analog, is a safe medication to terminate a pregnancy. However, misoprostol can cause coronary artery vasospasm due to vasoconstrictor properties, leading to acute myocardial infarction with nonobstructive coronary arteries (MINOCA), especially in patients with a high risk for cardiovascular disease. We report a case of a 42-year-old female with a past medical history of hypertension who presented with ST-elevation myocardial infarction following the administration of a high-dose Misoprostol. The fact that coronary angiogram and intravascular ultrasound revealed normal coronary arteries suggested transient coronary vasospasm. CVS is a severe but rare cardiac adverse effect associated with high-dose misoprostol. This medication should be prescribed with caution and close monitoring, especially in those with pre-existing heart disease or cardiovascular risk factors. Our case raises awareness of severe cardiovascular complications that can be related to using misoprostol in high-risk patients.

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Misoprostol

2020

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Coronary artery vasospasm after misoprostol treatment for incomplete abortion: a case report

Cited by 6 publications

References 14 publications

Reactions to Misoprostol: A Case Report

Reactions to Misoprostol: A Case Report

A case report and literature review of myocardial infarction with nonobstructive coronary arteries (MINOCA) possibly due to acute coronary vasospasm induced by misoprostol

Misoprostol

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