Postpartum myocardial infarction in a patient receiving bromocriptine

Abstract

A case of a postpartum myocardial infarction in a 27-year-old black multiparous woman is presented. The patient had postpartum pregnancy-induced hypertension in a previous pregnancy. Her most recent pregnancy and immediate postpartum period had been uncomplicated, and she had been sent home with bromocriptine to suppress lactation. Ten days postpartum, she presented with severe hypertension followed by cardiac arrest. Subsequent coronary catheterization revealed no evidence of coronary atherosclerosis but showed a 60-70% stenotic plaque in the left anterior descending artery, possibly secondary to coronary artery spasm. A review of all previously reported cases of postpartum myocardial infarction is presented in an effort to identify the possible etiology of this event and to consider the role of bromocriptine. The most common associated finding in all cases was a history of pregnancy-induced hypertension, which may have been associated with a predisposition to coronary vasospasm. The compounding role of ergot derivatives on vasospasm is considered.