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Methylergonovine-induced diffuse coronary spasm in a patient with exercise-induced coronary spasm after heart
R P Frantz1, A Lerman, B S Edwards
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
Insights
Coronary artery spasm is rare after heart transplantation. Intravenous methylergonovine maleate should be avoided due to risks of severe spasm, hypotension, and ventricular fibrillation in transplant patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Physiology
Background:
- Coronary artery spasm is infrequently documented post-heart transplantation.
- Exercise-induced coronary artery spasm presents a diagnostic challenge in this population.
Observation:
- A case study details a patient experiencing coronary artery spasm one year after orthotopic heart transplantation.
- Quantitative coronary angiography revealed significant diffuse luminal diameter reduction.
- Provocative testing with intracoronary acetylcholine and intravenous methylergonovine maleate was employed.
Findings:
- Intracoronary acetylcholine infusion caused transient left anterior descending artery closure.
- Intravenous methylergonovine maleate triggered diffuse spasm, leading to hypotension and ventricular fibrillation.
- Literature review indicates coronary artery spasm post-transplantation often correlates with severe transplant coronary artery disease and poor prognosis.
Implications:
- Intravenous methylergonovine maleate administration poses significant risks and should be avoided in the post-transplant setting.
- Coronary artery spasm may be an underrecognized cause of syncope and mortality in heart transplant recipients.
- Further research is warranted to elucidate the mechanisms and management of coronary artery spasm after heart transplantation.
Abstract:
Coronary artery spasm is a rarely reported condition after heart transplantation. We report a case of exercise-induced coronary artery spasm in a patient 1-year after orthotopic heart transplantation. Serial quantitative coronary angiography showed significant diffuse loss of luminal diameter. Provocative testing with intracoronary acetylcholine and intravenous methylergonovine maleate was performed in an effort to document efficacy of the antispasm regimen. Infusion of acetylcholine into the left anterior descending coronary artery resulted in transient closure of the vessel. Diffuse spasm resulting in hypotension and ventricular fibrillation occurred with intravenous methylergonovine maleate administration. Because of the risk of provoking diffuse spasm, intravenous administration of methylergonovine maleate should be avoided in the posttransplantation setting. Review of the literature suggests that coronary artery spasm after transplantation is often associated with severe transplant coronary artery disease and may be associated with a poor prognosis. Coronary artery spasm may be a more common cause of syncope and death after transplantation than it is currently thought to be.