Acute Coronary Artery Vasospasm Associated with Misoprostol for Termination of Pregnancy

Abstract

Prostaglandin E₁ analogues, gemeprost and misoprostol, are the most widely used drugs for medical termination of pregnancy within the first two trimesters of pregnancy. Gemeprost has been reported to be associated with acute cardiovascular accidents in a few cases, but no adverse cardiovascular events have been reported with misoprostol. For this reason, misoprostol has been considered a potentially safer drug and is widely recommended as a first-choice drug in combination with mifepristone. We report a case of a 32-year-old woman with active smoking and obesity, who developed an episode of transient acute coronary artery vasospasm following the administration of intravaginal misoprostol. This report illustrates that misoprostol can also be associated with acute coronary events, although it remains to be evaluated whether the risk is similar or lower to gemeprost.

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

“…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).…”

Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest

“…Prashanth et al report two cases of misoprostol-induced severe vasospasm leading to a hypertensive crisis requiring mechanical ventilation [2] . Illa et al reported the case of a 32-year-old woman who developed an episode of transient acute coronary artery vasospasm following the administration of intravaginal misoprostol [3] . Owusu et al described a case of successful cardiac resuscitation after the administration of intravenous nitroglycerin during prolonged cardiac arrest secondary to coronary artery vasospasm in the setting of recent misoprostol ingestion [4] .…”

Successful management of pregnancy and delivery in a woman with multiple coronary stenoses of unknown cause

“…Because of the risk of hypertensive cardiovascular complications, its use is limited and methylergometrine is not recommended as the first choice in routine obstetric practice 12 . Prostaglandin E 1 and E 2 analogues are potent stimulants of uterine contraction with selective myometrial action and few gastrointestinal effects, but with potential cardiovascular effects attributed to coronary spasm 13,14 …”

“…12 Prostaglandin E1 and E2 analogues are potent stimulants of uterine contraction with selective myometrial action and few gastrointestinal effects, but with potential cardiovascular effects attributed to coronary spasm. 13,14 Nicorandil, a nicotinamide ester, is a potassium channel activator used in the prevention and long-term treatment of angina pectoris. 15 It is a drug that acts as an arteriolar vasodilator, but also as a venodilator because of its nitrate moiety.…”