Misoprostol: From cervical softening to coronary stiffening

Introduction This case of misoprostol-induced coronary vasospasm demonstrates the rare but potentially serious cardiac-related adverse events which arose from the use of misoprostol in a young healthy adult with no past cardiac history of note. Case Presentation A 37-year-old female with a history of idiopathic vasculitis but no known cardiovascular risk factors was administered misoprostol vaginally for an elective outpatient hysteroscopy. She developed typical cardiac symptoms of severe chest pain and her initial electrocardiogram demonstrated changes mimicking an anterolateral ST-elevation myocardial infarction. Fortunately, her symptoms resolved shortly before her presentation to the Emergency Department, and her cardiac troponin levels were within normal limits. She underwent further workup during her inpatient stay in a Cardiology ward which revealed no evidence of coronary artery disease, and she was discharged with the rare diagnosis of misoprostol-induced coronary vasospasm. Discussion and Conclusion This case illustrates the importance of physician awareness to patients who present with cardiac symptoms following misoprostol administration. We recommend that misoprostol be administered with caution in patients with vasculitis or traditional cardiovascular risk factors and that these high-risk patients should be counselled for the potential of rare but serious cardiac-related adverse events arising from coronary vasospasm.