de Labriolle Axel, Genée Olivier, Heggs Laurens Mitchell, Fauchier Laurent
Service de Cardiologie, Pôle Coeur Thorax Vasculaire Hémostase, Centre Hospitalier Universitaire Trousseau, 37044, Tours, France.
Cardiovasc Toxicol. 2009 Mar;9(1):46-8. doi: 10.1007/s12012-009-9031-9. Epub 2009 Feb 14.
Ergot derivatives are frequently administrated during cesarean delivery, induced abortion, or post-partum hemorrhage to promote uterine contractions. Ergot derivatives may also induce coronary spasm and intravenous ergonovine is used in cardiac catheterization laboratories as a diagnostic agent. Serious ischemic cardiac events related to ergonovine are rare and have most often been described after intravenous use. We report the case of a 38-year-old woman with a ST elevation myocardial infarction (STEMI) few days after artificially induced abortion by oral prescription of methylergometrine. Coronary angiography performed 2 days after onset of chest pain did not reveal any abnormalities of the coronary arteries but a provocative test using intravenous methylergometrine was positive with reproduction of chest pain, ECG changes and with a significant narrowing localized on the second segment of the left anterior descending artery at the angiogram. Thus, since methylergometrin may clearly induce coronary spasm when prescribed orally, chest pain occurring under oral treatment should require immediate attention even if atypical or in the absence of cardiovascular risk factors.
麦角衍生物常用于剖宫产、人工流产或产后出血时，以促进子宫收缩。麦角衍生物也可能诱发冠状动脉痉挛，静脉注射麦角新碱在心脏导管实验室用作诊断剂。与麦角新碱相关的严重缺血性心脏事件很少见，且大多在静脉使用后被描述。我们报告一例38岁女性，在口服甲基麦角新碱人工流产几天后发生ST段抬高型心肌梗死（STEMI）。胸痛发作2天后进行的冠状动脉造影未发现冠状动脉有任何异常，但静脉注射甲基麦角新碱的激发试验呈阳性，出现胸痛再现、心电图改变，血管造影显示左前降支动脉第二段有明显狭窄。因此，由于口服甲基麦角新碱时可能明显诱发冠状动脉痉挛，口服治疗时出现的胸痛即使不典型或无心血管危险因素也应立即引起重视。
