The online version of this article contains two videos. The article and the video are available online (https://doi.org/10.1007/s12471-023-01805-z). The videos can be found in the article back matter as ‘Electronic Supplementary Material’.
A 32-year-old pregnant woman was admitted with placental abruption, and a caesarean section was performed. Postpartum haemorrhage ensued, which was treated with oxytocin, methylergometrine and sulprostone. Shortly thereafter she developed ventricular fibrillation and cardiogenic shock. Electrocardiography showed sinus tachycardia with alternating right and left bundle branch block. Transthoracic echocardiography demonstrated a severely impaired left ventricular function with apical and septal akinesia and basal hyperkinesias. Coronary angiography revealed spasm of the left anterior descending coronary artery, which was successfully treated with intracoronary nitroglycerin (Figs. 1a, b). Because of continuing cardiogenic shock, a microaxial flow device was implanted and systemic vasodilators were started. Cardiac contractility recovered rapidly and she was discharged in good clinical condition.
Fig. 1
a Occlusion of mid-left anterior descending artery (left anterior oblique view 1°, cranial view 30°) before and after intracoronary nitroglycerin. b Left anterior descending artery wrapping around the apex (TIMI III flow). (Right anterior oblique view 2°, cranial view 31°)
×
Methylergometrine and sulprostone are frequently used in uncontrolled postpartum bleeding and seldom lead to coronary artery spasm-induced cardiogenic shock [1‐4]. In this case, we demonstrated effective treatment with antispasmodic therapy combined with temporary mechanical circulatory support.
Conflict of interest
P.M.L. Zomer, M.P.A. Van Teeffelen, L.C. Otterspoor and M.J.A. Kamps declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
