Transient sick sinus syndrome with complete AV block due to
More mature or older women are more likely to undergo in vitro fertilization and embryo implant. These women have a greater chance of receiving ergonovine therapy because of a suspected abortion.

Published in Medicine, the authors present this case report to call attention to a latent lethal adverse effect in everyday obstetric practice using ergonovine. It requires more attention and close monitoring. Presented herein is the case of a 38-year-old female patient with general weakness and mild chest tightness after ergonovine use.

A 38-year-old female patient received in vitro fertilization (IVF) 1 month prior to hospitalization. Swelling in the right adnexa without intrauterine embryo was found in a routine follow-up transvaginal ultrasonography. The right adnexa mass was found to be a hydrosalpinx, rather than an ectopic embryo, using exploratory laparoscopy.

Vaginal bleeding presented after the laparoscopic surgery, so oral ergonovine (0.2 mg, t.i.d.) was given to facilitate uterine contraction, under the impression of complete abortion. However, by the time the patient took the fourth dose of ergonovine, she began to suffer from general weakness and mild chest tightness. The patient's vital signs were stable: systolic/diastolic blood pressure, 114/66 mm Hg; heart rate, 41 beats/min; respiratory rate, 20 breaths/min; and temperature, 36.5°C.

But ECG demonstrated a complete AV block presenting with type 1 and type 2 second-degree sino-atrial exit block and junctional escape rhythm. The hemogram, biochemistry (including electrolytes, a series of cardiac enzyme tests, blood gas analysis, and prothrombin time), and autoimmune markers (including C3, C4, double-strand DNA, rheumatic factor, anti-beta2 glycoprotein IgG, anti-cardiolipin IgG, and IgM) were all within normal limits.

Ergonovine was suspected to be the cause of these adverse effects since the symptoms first emerged. The Naranjo adverse drug reaction (ADR) causality score was 5, which represented probable ADR of ergonovine in this case.

Conservative treatment and bed rest were suggested to the patient, and her sinus rhythm returned to normal the day after ergonovine was discontinued. ECG was arranged in a time sequence manner. The patient refused further electrophysiologic study because of the IVF program. She has remained symptom-free since recovery of her sinus rhythm.

Lessons learnt:-
- Ergonovine may cause symptomatic and lethal bradyarrhythmia.

- Withdrawal of the causative medication and adequate supportive care can lead to a favorable outcome in these patients.

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