Acute Myocardial Infarction Complicating Sudden Interruption of Chronic Prostacyclin Therapy for Pulmonary Hypertension

In Brief Continuous intravenous prostacyclin (Epoprostenol) has recently been shown to improve exercise capacity, cardiopulmonary hemodynamics, New York Heart Association (NYHA) functional class, and indices of dyspnea in systemic sclerosis patients who develop severe pulmonary hypertension. However, chronic prostacyclin therapy may be associated with significant complications. We review the common adverse effects and complications of this therapy and present a novel case of a patient who suffered an acute myocardial infarction from accidental interruption of her continuous prostacyclin infusion. Continuous prostacyclin infusion therapy increases exercise tolerance and improves survival in patients with pulmonary arterial hypertension. However, it is associated with many side effects of varying severity. Once started, however, it is either continued for life or until lung transplantation but there are few data on the consequences of its gradual or sudden discontinuation. This article discusses the common side effects of chronic prostacyclin therapy and presents a novel case of an acute myocardial infarction complicating sudden infusion interruption.