Acute myocardial infarction after ergonovine administration for uterine bleeding

Acute myocardial infarction (AMI; heart attack) during pregnancy and after delivery is a rare phenomenon, the cause of which remains unknown. It has been reported to occur in women suffering from diabetes mellitus, coronary artery disease, and high blood pressure; in some cases there appears to be no particular precipitating factor. A case is reported of a physically active, 34-year-old white woman who was hospitalized following a spontaneous abortion (miscarriage) during the course of her third pregnancy. (Her previous pregnancies were uncomplicated.) She had a history of cigarette smoking and migraine headaches, but denied any drug abuse. Because of persistent uterine bleeding, ergonovine (a drug that stimulates uterine contractions) was administered by intramuscular injection. Within 30 minutes of ergonovine injection, the patient developed crushing chest pain, and her blood pressure dropped to dangerously low levels. Electrocardiographic diagnosis indicated that a heart attack was occurring; treatment took the form of fluid, norepinephrine and nitroglycerine administration. Thrombolytic (clot-dissolving) drugs were not administered because of a recent surgical procedure. Follow-up evaluation indicated minimal (but detectable) damage to the heart muscle. The patient was put on a regimen of diltiazem (a calcium channel-blocking drug), and has returned to her previous level of activity with no apparent adverse effects. Physicians administering ergonovine to obstetrical patients should be aware of the possibility of this rare but life-threatening side effect of this drug. (Consumer Summary produced by Reliance Medical Information, Inc.)