Milrinone infusion: a therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty.

Abstract

A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails.

• Authors: Amarpal Singh, Rajesh Chand Arya, Bishav Mohan
• Journal: Annals of cardiac anaesthesia (Ann Card Anaesth) 2009 Jan-Jun Vol. 12 Issue 1 Pg. 67-70 ISSN: 0974-5181 [Electronic] India
• PMID: 19136759 (Publication Type: Case Reports, Journal Article)

Chemical References

• Vasodilator Agents
• Milrinone

Topics

• Adult
• Angioplasty, Balloon, Coronary (adverse effects)
• Coronary Vasospasm (drug therapy, etiology)
• Emergencies
• Humans
• Infusions, Intravenous
• Male
• Milrinone (therapeutic use)
• Myocardial Infarction (therapy)
• Treatment Outcome
• Vasodilator Agents (therapeutic use)