Coronary artery spasm culminating in thrombosis following ergonovine stimulation

Jt, Hays; Rd, Hamill; Ca, DeFelice; Ae, Raizner

doi:10.1002/ccd.1810280306

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…However, severe coronary vasospasm has been reported [3][4]. There have been few reports of severe coronary vasospasm-induced thrombus formation secondary to possible endothelial damage [5][6][7][8][9][10]. Endothelium of the coronary arteries inhibits platelet aggregation by formation and release of prostacyclin, and it reacts to platelet products by causing relaxation of the underlying smooth muscle.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with coronary artery spasm usually have morphologic changes in the artery at the site of the spasm. Platelets can aggregate at this site and release vasoactive substances, which-aided by formation of thrombin-cause contraction [6,[8][9][10]. Literature shows coronary vasospasm occurring usually within one month of phentermine therapy [3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Cases of AMI from severe coronary vasospasm have been reported with phentermine, a weight loss medication and an amphetamine derivative, but coronary artery thrombosis has not [3][4]. However, the literature review does show the possibility of coronary artery thrombosis secondary to endothelial damage from prolonged severe coronary vasospasm in patients without evidence of atherosclerotic plaque rupture [5][6][7][8][9][10][11]. More recently, coronavirus disease 2019 (COVID-19) has been shown to be associated with various thromboembolic phenomena, however, the majority of cases involving acute coronary artery occlusion have been observed in hospitalized patients with concurrent respiratory failure [12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

Sikandar¹,

Butler²,

Battula³

et al. 2021

Cureus

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Acute ST-elevation myocardial infarction (STEMI) is rarely seen in young adults, however, when encountered, the underlying cause is either a genetic condition leading to early-onset coronary artery disease (CAD), an acquired pro-thrombotic condition, or an idiopathic condition like spontaneous coronary artery dissection (SCAD). Our case describes a healthy 23-year-old female who presented with sudden onset severe angina and was found to have a laminated thrombus in the left anterior descending coronary artery (LAD), with no evidence of intraluminal dissection or plaque rupture. Although the underlying etiology of thrombus formation remains unknown, coronavirus disease 2019 (COVID-19) related thrombotic event is the prime suspect. In addition, another culprit that cannot be excluded is phentermine-induced coronary vasospasm, a commercially available medication for weight loss. This report addresses current literature on acute coronary syndromes in young adults and reviews the potential etiologies for coronary artery thrombosis, which led to a near-fatal acute coronary syndrome in our patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

Sikandar¹,

Butler²,

Battula³

et al. 2021

Cureus

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“…Ergometrine is a potent vasoconstrictor, which is also used in provocation testing for coronary vasospasm. Refractory vasospasm culminating in MI is a recognised complication in this setting, and occlusive coronary artery spasm leading to in situ thrombosis has been shown angiographically 3. However, there have been only two previous reports of MI resulting from postpartum use of ergometrine 4…”

Section: Discussionmentioning

confidence: 99%

Postpartum acute MI following routine ergometrine administration treated successfully by primary PTCA

Sutaria

O’Toole²,

Northridge³

2000

Heart

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A 28 year old white woman had an unplanned home birth due to a short second stage of labour. A healthy boy was delivered vaginally with a midwife in attendance. Before delivering the placenta the patient was given 1 ml of intramuscular Syntometrine (ergometrine maleate 500 µg, oxytocin 5 units; Novartis, Surrey, UK). The placenta and membranes were delivered completely with minimal blood loss. Fifteen minutes later the patient complained of severe central chest tightness radiating to both arms and associated with profuse sweating, nausea, and breathlessness. She was transferred to a local maternity hospital for further assessment.On admission her ECG showed ST segment elevation across the chest leads with 6 mm of ST elevation in leads V4 and V5 confirming an acute anterior myocardial infarction (MI). She was transferred to the coronary care unit at a nearby district general hospital. Thrombolysis was withheld due to the risk of postpartum haemorrhagic complications and she was immediately transferred to a tertiary referral centre 25 miles away where she underwent emergency cardiac catheterisation.The patient had been well previously with no cardiac symptoms and two entirely uncomplicated pregnancies. However, she was a heavy smoker and hypercholesterolaemia was diagnosed after both parents died from coronary artery disease in their early 40s.Coronary angiography revealed diVuse three vessel coronary artery disease with an acute occlusion in the proximal left anterior descending coronary artery (TIMI grade 0 flow) ( fig 1A). The occlusion was dilated with a 3 mm balloon followed by insertion of a 9 mm NIR stent with a good angiographic result ( fig 1B). TIMI grade 3 flow was restored to the infarct related artery within half an hour of arrival at the tertiary centre (5.5 hours after the onset of chest pain). A subsequent ECG showed resolution of ST elevation and Q waves in leads V1-4. Creatinine kinase (CK) peaked at 9858 U/l (8% CK-MB isoenzyme). Echocardiography showed anteroseptal hypokinesis but other segments of the left ventricle contracted well. Her recovery was uncomplicated. DiscussionAcute MI occurs rarely in women of childbearing age and has a reported incidence in pregnancy of 1 in 10 000.1 MI is more frequent during the third trimester and puerperium of the first and second pregnancies and most commonly involves the left anterior descending artery territory. In the immediate postpartum period spontaneous coronary artery dissection is the most common cause of MI.2 In 20% of

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Anatomie und Pathologie der Koronararterien

Hort¹,

Schwartzkopff²

2000

Pathologie Des Endokard, Der Kranzarterien Und Des Myokard

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Coronary artery spasm culminating in thrombosis following ergonovine stimulation

Cited by 10 publications

References 18 publications

ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

Postpartum acute MI following routine ergometrine administration treated successfully by primary PTCA

Anatomie und Pathologie der Koronararterien

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