Sumatriptan-Induced Coronary Artery Vasospasm Leading to Acute ST Elevation Myocardial Infarction

Sumatriptan, a 5-HT1 receptor agonist, is a highly effective treatment for migraines, replacing ergotamine as the mainstay therapy. However, its use has been associated with coronary vasospasm due to the presence of 5-HT1-like receptors in coronary arteries, which can lead to acute myocardial infarction (AMI). This report presents the case of a 50-year-old female patient with a history of hypertension treated on lisinopril with no previous cardiac evaluations and no prior history of chest pain, a family predisposition to coronary artery disease who presented with chest pain and experienced ischemic electrocardiographic changes following a sumatriptan injection. Despite a normal baseline electrocardiogram and non-obstructive coronaries on coronary angiography, the patient reported severe chest pain after sumatriptan administration, which resolved with nitrate treatment. This case highlights the possibility of AMI following sumatriptan use with non-obstructive coronaries and the need for careful patient evaluation for coronary risk factors prior to prescribing sumatriptan. The patient did not report any episodes of chest pain on the initial clinic evaluation post discharge from the hospital. Patients should be informed of the risk of myocardial infarction and advised to seek medical attention if they experience chest pain. It underscores the importance of thorough risk assessment and patient education when considering sumatriptan for migraine treatment.