Motaweih Mohammad A, Baraskar Bhavana, Shin Yongdeok B, Iantorno Micaela
Internal Medicine, Mary Washington Hospital, Fredericksburg, USA.
Cardiology, Mary Washington Hospital, Fredericksburg, USA.
Cureus. 2025 Aug 21;17(8):e90655. doi: 10.7759/cureus.90655. eCollection 2025 Aug.
Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute coronary syndrome (ACS), myocardial infarction (MI), and sudden cardiac death, particularly in younger individuals without traditional cardiovascular risk factors. Pregnancy-associated SCAD (P-SCAD) is a specific subset of SCAD that accounts for a significant number of MIs in pregnant and postpartum women. Misoprostol is a prostaglandin E1 analogue that is used for medical termination of pregnancy and has been associated with coronary vasospasm in rare cases; however, our case highlights a potential new association between this drug and SCAD. A 29-year-old African American woman with no significant past medical history presented to the emergency room with seizure-like activity and unresponsiveness witnessed by her sister while they were traveling on a road trip few hours after taking Misoprostol for termination of an ectopic pregnancy. Coronary angiography showed focal 95% stenosis of the proximal left anterior descending (LAD) artery with TIMI 1 flow concerning spontaneous coronary artery dissection versus coronary vasospasm. A decision was made to proceed with percutaneous coronary intervention to the LAD. The procedure was complicated by no reflow and retrograde advancement of dissection/hematoma to the left main coronary artery, requiring further stenting with overlapping stents from the ostial left main coronary artery to the proximal LAD artery. During the procedure, the patient developed multiple cardiac arrests with pulseless electrical activity requiring advanced cardiac life support, pressors, and left ventricular assist device (LVAD) placement for mechanical circulatory support. She subsequently showed marked improvement and was successfully weaned off vasopressors, and the LVAD was removed by day 4 in the ICU. On day 8, the patient was successfully extubated. The follow-up 2D echocardiogram showed improvement in the ejection fraction to 40-45%. The patient was safely discharged and made significant cardiovascular recovery. This is an interesting case discussion highlighting a rare and potential association between a commonly prescribed medication and a serious cardiovascular complication. It has been observed that SCAD occurs with higher frequency during pregnancy, peripartum period, and with the use of exogenous hormones although the exact etiology remains unclear. More research should be done to better understand the potential cardiovascular adverse effects of Misoprostol, especially on patients with underlying SCAD.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）、心肌梗死（MI）和心源性猝死的一种罕见但日益被认识到的病因，尤其在没有传统心血管危险因素的年轻个体中。妊娠相关SCAD（P-SCAD）是SCAD的一个特定子集，在怀孕和产后妇女的心肌梗死中占相当大的比例。米索前列醇是一种前列腺素E1类似物，用于药物流产，在罕见情况下与冠状动脉痉挛有关；然而，我们的病例突出了这种药物与SCAD之间一种潜在的新关联。一名29岁无重大既往病史的非裔美国女性在服用米索前列醇终止异位妊娠几小时后，在公路旅行途中被她的姐姐发现出现癫痫样活动且无反应，随后被送往急诊室。冠状动脉造影显示左前降支（LAD）近端局灶性95%狭窄，TIMI 1级血流，考虑为自发性冠状动脉夹层与冠状动脉痉挛。决定对LAD进行经皮冠状动脉介入治疗。该手术出现了无复流并发症，夹层/血肿逆行扩展至左主干冠状动脉，需要从左主干冠状动脉开口到LAD近端置入重叠支架进一步进行支架置入术。在手术过程中，患者出现多次心脏骤停，伴有无脉电活动，需要高级心脏生命支持、血管加压药以及置入左心室辅助装置（LVAD）进行机械循环支持。她随后明显好转，成功停用血管加压药，在重症监护病房第4天拔除LVAD。第8天，患者成功拔管。随访二维超声心动图显示射血分数提高到40 - 45%。患者安全出院，心血管功能显著恢复。这是一个有趣的病例讨论，突出了一种常用药物与一种严重心血管并发症之间罕见且潜在的关联。据观察，SCAD在孕期、围产期以及使用外源性激素时发生率较高，尽管确切病因仍不清楚。应该进行更多研究以更好地了解米索前列醇潜在的心血管不良反应，尤其是对潜在患有SCAD的患者。
