[Prolonged angina after the administration of a synthetic PGE2 derivative]. / Angina prolungata dopo somministrazione di un derivato sintetico di PGE2.

We describe the case of a 39-year-old woman, heavy smoker, who received 500 micrograms i.m. of Sulprostone, a synthetic PGE2-derivative, to induce pregnancy termination. Sulprostone is usually administered either to cause abortion in preparation of an instrumental operation or to induce delivery after the intrauterine death of the fetus. This drug has a dilating effect on the cervix uteri and stimulates the uterus muscles. After about fifteen minutes the patient experienced a constrictive chest pain which progressively worsened and spread to the upper limbs. The pain disappeared for a short period and then recurred with greater intensity, accompanied by bradycardia and hypotension. The ECG showed sinus bradycardia, second- and third-degree atrioventricular block, S-T segment elevation in the inferior leads and reciprocal depression in the anterior leads. Intravenous nitroglycerin therapy induced a rapid reduction of the clinical symptoms and changes in the ECG. There was no increase in cardiac enzymes. The exercise test, the cold pressor test and the ECO-dipyridamole test were negative. The patient refused to undergo the ergonovine test and coronary angiography. We hypothesize that the Sulprostone either had a dipyridamole-like effect or that it induced a paradoxal coronary spasm.

[Possibility of evaluation of chest pain at the time of hospitalization]. / Possibilità di valutazione del dolore toracico al momento del ricovero in ospedale.

A series of 140 patients admitted to an Internal Medicine or a Cardiology Department for an acute chest pain is examined in order to evaluate the possibility of reaching a quick diagnosis, particularly for coronaric heart diseases, according with history, physical examination, electrocardiogram. In most of cases it was possible an immediate, correct evaluation of the patients, but in some cases a right diagnosis was achieved only after a period of observation and different investigations.