Problems for Discussion - 2 - Ergots

A 56-year-old male is brought by ambulance to the Emergency Department with chest pain. His only past history is of migraine for which he took Cafergot. He had been taking 4 tablets a day for the last 5 days and a total of 14 tablets on the day of presentation. His pulse rate was 100/min., BP 150/90. An ECG showed ST elevation of 2 mm in leads V2-V5. He has no cardiac risk factors.

1. What is the relationship between his chest pain and cafergot ingestion, if any?
2. Detail your initial treatment.
3. A cardiologist and a cardiac catheter lab are available. Are angiography and any specific procedures indicated?

A 30-year-old woman presents with severe ischaemia to the hands and feet. It commenced 6 weeks ago with claudication and progressed to rest pain. Her systolic blood pressure is 80 mmHg. Femoral pulses were 3/4. Radial, popliteal and ankle pulses were impalpable and the extremities were blue and cold. Her only background was migraine for which she had been taking ergotamine 2 mg suppositories, on average two a day, for the last 6 months.

1. What investigations are required?
2. What treatment options are there? What do you recommend and why?
3. What would you recommend for management of this patient’s migraine?