Postpartum bradycardia is an uncommon, generally self-limiting condition with limited published data. It has been associated with pre-eclampsia, medications and neuraxial anaesthesia.1 We present the case of a previously well G2P2 woman admitted two weeks postpartum for management of recurrent mastitis who developed significant hypertension and bradycardia within 30 hours of receiving her first dose of cabergoline for lactation suppression. An initial trial of hydralazine resulted in transient improvement; however, resolution of both hypertension and bradycardia occurred following cessation of cabergoline and treatment with prazosin.
Although cabergoline is generally associated with orthostatic hypotension due to its dopaminergic agonist activity, its ergot-derived structure and broader serotonergic and adrenergic receptor interactions may contribute to paradoxical hypertensive effects.2 The mechanism of associated bradycardia remains incompletely understood, although emerging evidence suggests a potential role for autonomic dysregulation.2 There is only one other reported case of cabergoline associated hypertension and bradycardia.3
This case highlights ergot derivatives as a potential cause of postpartum hypertension and bradycardia and describes the successful use of prazosin in their management.