Mitral valve disease associated with long-term ergotamine use

A 43-year-old woman with symptoms and signs of congestive heart failure and intermittent claudication was found to have moderately severe mitral stenosis and regurgitation, as well as severe bilateral upper and lower extremity arterial occlusive disease. She had a history of migraine headaches and had abused ergotamine tartrate (Cafergot) chronically for more than 20 years. Only rare instances of valvular heart disease have been associated with chronic ergotamine toxicity, with the majority of previously reported cases based on auscultatory findings alone.