A 32-year-old pregnant woman was admitted with placental abruption, and a caesarean section was performed. Postpartum haemorrhage ensued, which was treated with oxytocin, methylergometrine and sulprostone. Shortly thereafter she developed ventricular fibrillation and cardiogenic shock. Electrocardiography showed sinus tachycardia with alternating right and left bundle branch block. Transthoracic echocardiography demonstrated a severely impaired left ventricular function with apical and septal akinesia and basal hyperkinesias. Coronary angiography revealed spasm of the left anterior descending coronary artery, which was successfully treated with intracoronary nitroglycerin (Figs. 1a, b). Because of continuing cardiogenic shock, a microaxial flow device was implanted and systemic vasodilators were started. Cardiac contractility recovered rapidly and she was discharged in good clinical condition.
a Occlusion of mid-left anterior descending artery (left anterior oblique view 1°, cranial view 30°) before and after intracoronary nitroglycerin. b Left anterior descending artery wrapping around the apex (TIMI III flow). (Right anterior oblique view 2°, cranial view 31°)
Methylergometrine and sulprostone are frequently used in uncontrolled postpartum bleeding and seldom lead to coronary artery spasm-induced cardiogenic shock [1,2,3,4]. In this case, we demonstrated effective treatment with antispasmodic therapy combined with temporary mechanical circulatory support.
References
Escobar MF, Nassar AH, Theron G, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynecol Obstet. 2022;157(Suppl. 1):3–50.
Bateman BT, Huybrechts KF, Hernandez-Diaz S, Liu J, Ecker JL, Avorn J. Methylergonovine maleate and the risk of myocardial ischemia and infarction. Am J Obstet Gynecol. 2013;209:459.e1–459.13.
Spencer SPE, Lowe SA. Ergometrine for postpartum hemorrhage and associated myocardial ischemia: two case reports and a review of the literature. Clin Case Rep. 2019;7:2433–42.
Feenstra J, Borst F, Huige MC, Oei SG, Stricker BH. Acuut myocardinfarct na toediening van sulproston. Ned Tijdschr Geneeskd. 1998;142:192–5. [Acute myocardial infarct following sulprostone administration].
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P.M.L. Zomer, M.P.A. Van Teeffelen, L.C. Otterspoor and M.J.A. Kamps declare that they have no competing interests.
Supplementary Information
CAG before intracoronary nitroglycerin
CAG after intracoronary nitroglycerin
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Zomer, P.M.L., van Teeffelen, M.P.A., Otterspoor, L.C. et al. Postpartum cardiogenic shock due to coronary artery spasm after methylergometrine and sulprostone administration. Neth Heart J 31, 408–409 (2023). https://doi.org/10.1007/s12471-023-01805-z
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DOI: https://doi.org/10.1007/s12471-023-01805-z