Cabergoline
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Spontaneous coronary artery dissection: case report A 31-year-old woman developed spontaneous coronary artery dissection (SCAD) during treatment with cabergoline for prolactinoma. The woman, who had hypertension and had been receiving amlodipine, presented with chest pain. Her medical history was significant for symptoms characteristic of galactorrhoea, amenorrhoea, delivered a child 11 years previously, and infertility (2 years previously). She denied drug, alcohol or tobacco use, and she had no family history of genetic disease, sudden death or cardiac disease. An MRI had showed a pituitary mass, with a prolactin level of 236 ng/mL 7 months previously. Therefore, she had received cabergoline 0.25mg twice weekly [route not stated] for prolactinoma. Following completion of 3 months of therapy, she had stopped refilling the prescription. Three weeks later (3 months prior to the current presentation), she had visited the emergency department with chest pain. She was subsequently discharged, and the cabergoline therapy was re-initiated at the previous dose of 0.25mg twice weekly. At the time of current presentation, she was noted to be anxious with physical distress caused by intermittent chest pain on physical examination. Her heart rate was 62 beats/minute and BP was 164/10mm Hg. An ECG revealed diffuse T-wave inversions in II, III, aVf and V1 to V6, and troponin I level was noted to be 0.06 ng/mL. The woman started receiving aspirin and clopidogrel at a hospital, where she had initially presented. Then, she presented to another center with troponin I level at 2.8 ng/mL. A coronary angiogram showed diffuse 99% stenosis of the proximal to mid-left anterior descending artery, 90% stenosis at the first diagonal branch and a total occlusion of the mid right coronary artery (RCA), without visible collaterals. The RCA was noted likely to be an acute flow-limiting dissection and the culprit lesion. An echocardiography demonstrated 60% of ejection fraction, with hypokinesis of the inferior and septal wall. Based on the staccato chest pain, which was related to high BP, she was suspected to have developed coronary artery dissection. She had non-ST-segment elevation myocardial infarction with double vessel coronary artery dissection. Blood pressure control led to resolution of the chest pain. Then, she underwent placement of an intra-aortic balloon pump, and she was treated with heparin and nitroglycerine until she underwent coronary artery bypass grafting (CABG) as a definitive treatment. However, 10 hours later, she experienced a recurrence of chest pain, with increasing troponin I (6.5 ng/mL). Therefore, she was taken for on-pump CABG. She underwent CABG, wherein the left internal thoracic artery was anastomosed to the left anterior descending artery, the right internal thoracic artery was anastomosed to the RCA, and the radial artery was anastomosed to the diagonal artery. The tissue along the diagonal artery and left anterior descending artery were noted to be inflamed and swollen. After the arteries were opened, th
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