Triptans and troponin: a case report
Claudia R Weder1, Markus Schneemann
1Department of Internal Medicine, University Hospital of Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland. claudia.weder@usz.ch
Orphanet Journal of Rare Diseases
|June 23, 2009
Summary
This case report details a 67-year-old experiencing acute coronary syndrome after taking naratriptan for migraine. This highlights potential cardiac risks associated with triptans, even in patients without prior heart disease.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Triptans are commonly prescribed for migraine headaches.
- Previous reports have linked certain triptans (sumatriptan, zolmitriptan, frovatriptan) to acute coronary syndromes.
- The cardiac safety profile of naratriptan, particularly in patients without pre-existing coronary artery disease, requires further investigation.
Observation:
- A 67-year-old woman presented with thoracic pain and ECG changes (T-wave inversions) after oral naratriptan intake.
- Cardiac biomarkers (troponin-T) were elevated, indicating myocardial injury.
- Coronary angiography revealed normal coronary arteries, ruling out obstructive coronary artery disease.
Findings:
- The patient's presentation was consistent with acute coronary syndrome.
- Naratriptan-induced coronary vasospasms are the presumed cause of the acute coronary syndrome.
- This is the first reported case of acute coronary syndrome associated with naratriptan use.
Implications:
- Triptans, including naratriptan, can precipitate acute coronary syndromes via coronary vasospasms, even in individuals without established coronary heart disease.
- Clinicians should exercise caution when prescribing triptans, especially in patients with cardiovascular risk factors.
- Patients experiencing severe or persistent chest pain after triptan use require prompt and thorough cardiac evaluation.
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