Zolmitriptan-induced acute myocardial infarction

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Triptans are first-line treatments for acute migraine attacks, targeting 5HT1B/1D receptors to cause cerebral vasoconstriction.
• While generally safe, triptan therapy is associated with thoracic pain in up to 7% of cases, typically mild and transient.
• The mechanism involves vasoconstriction of cerebral blood vessels, reduced vasoactive peptide secretion, and decreased pain conduction.

Observation:

• A 45-year-old woman with a history of migraine with visual aura presented with chest pain.
• She had no prior cardiovascular risk factors such as diabetes, hypertension, or smoking history.
• The chest pain occurred shortly after taking her monthly dose of oral zolmitriptan.

Findings:

• Electrocardiogram revealed an anterior myocardial infarction.
• Coronary angiography showed a normal coronary arterial system.
• Cardiac risk laboratory indices were within normal ranges, suggesting a non-atherosclerotic cause.

Implications:

• This case suggests a potential rare but serious cardiovascular adverse effect of triptan use, specifically zolmitriptan.
• It underscores the importance of considering triptans as a potential cause of myocardial infarction, even in patients without traditional cardiovascular risk factors.
• Permanent discontinuation of triptans was recommended for this patient to prevent recurrence.