Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest

Misoprostol is a synthetic E1 prostaglandin commonly used to induce abortion in the United States and elsewhere. There is limited literature on the cardiovascular adverse effects of misoprostol, and, to the best of our knowledge, very few such events have been reported. We describe the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and experienced a cardiac arrest due to coronary vasospasm. She was successfully resuscitated and echocardiography showed features consistent with Takotsubo cardiomyopathy. Coronary angiography revealed coronary artery spasm which responded to nitroglycerin. Our case adds to the limited literature on this life-threatening adverse event of misoprostol. LEARNING POINTS Misoprostol is frequently used obstetrics and gynaecology and routinely for the medical termination of pregnancy. Misoprostol can result in cardiac arrest due to coronary vasospasm. Coronary vasospasm induced by misoprostol can be relieved with intra-arterial nitroglycerin. Keywords: Misoprostol, Takotsubo cardiomyopathy, coronary vasospasm INTRODUCTION Misoprostol is a synthetic prostaglandin E1 analogue that primarily effects the mucosa in the gastrointestinal tract, causing acid suppression. However, it also has off-label use in obstetrics and gynaecology owing to its ability to induce uterine contractions, cervical softening and dilation. Due to its uterotonic properties, it is used for the medical termination of pregnancy, postpartum haemorrhage and induction of labour [1]. Misoprostol is considered a safe and well-tolerated drug. We report the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and had a cardiac arrest due to coronary vasospasm