Misoprostol
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Coronary artery spasm: case report A 40-year-old woman developed coronary artery spasm during treatment with misoprostol for the management of incomplete abortion. The woman, who was diagnosed with incomplete abortion, started receiving vaginal misoprostol 400µg daily for 4 days along with ibuprofen and paracetamol [acetaminophen]. Twenty-two hours later, she presented to the emergency room with complained of crushing chest pain radiating to the left arm, nausea, vomiting and dyspnoea. Symptoms started suddenly 20 min after the first misoprostol administration. She was found to be diaphoretic and pale. Her BP was 123/49mm Hg, heart rate was 66 beats/min and oxygen saturation was 100% without additional oxygen supply. An ECG revealed sinus rhythm (70 beats/min), narrow QRS and an ST-segment elevation on leads I, aVL and V2 to V5. Subsequently, she was diagnosed with the acute coronary syndrome. The woman was treated with aspirin [acetylsalicylic acid], clopidogrel and nitroglycerin. A few minutes following the starting of therapy, ST-segment elevation normalised, this was indicative of vasospastic component of the lesion. She was moved to a reference hospital for primary angioplasty. Coronary angiography showed severe stenosis in the middle segment of the left anterior descending artery and atherosclerotic plaque along with only mild stenosis. These findings were compatible with coronary spasm. Her condition recovered completely following administration of nitroglycerin. Subsequently, a direct drug-eluting stent was implanted in the lesion. She returned to the ICU and was recovered without any complications. Author comment: "The most common adverse effects of misoprostol are gastrointestinal, whereas cardiovascular effects are hardly known." "In conclusion, although very uncommon, the use of misoprostol may induce coronary artery spasm." Munoz-Franco FM, et al. Coronary artery vasospasm after misoprostol treatment for incomplete abortion: a case report. Contraception 100: 498-501, No. 6, Dec 2019. Available from: URL: http://doi.org/10.1016/j.contraception.2019.08.003 803442085 Spain
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Reactions 4 Jan 2020 No. 1785
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