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Fatal coronary vasospasm following oral triptan intake
Idir-Yanis Djellal1, Sohaïb Mansour1, Brahim Berdaoui1
1Cardiology Department, Brugmann University Hospital, Bruxelles, Belgium.
Journal of Cardiology Cases
|June 16, 2025
Summary
Triptans, used for migraines, can cause fatal coronary vasospasm and cardiac arrest, even in young, low-risk patients. Discontinue triptans immediately if chest pain occurs to prevent severe cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Triptans are 5HT1B/1D and 5HT1F receptor agonists used for migraine treatment.
- They induce vasoconstriction, with rare reports of coronary vasospasm.
Observation:
- A 30-year-old man with morbid obesity experienced chest pain after initiating sumatriptan for migraines.
- He developed cardiac arrest due to ventricular arrhythmias and left anterior descending artery vasospasm after taking sumatriptan.
Findings:
- Sumatriptan use precipitated fatal coronary vasospasm and myocardial infarction in a patient with minimal cardiovascular risk.
- Intracoronary nitrates and adenosine transiently relieved the vasospasm, but the patient succumbed to cardiogenic and distributive shock.
Implications:
- Triptans carry a potentially fatal cardiovascular risk, even in low-risk individuals.
- Heightened clinical suspicion for coronary vasospasm is crucial when chest pain follows triptan use.
- Discontinuation of triptans at the first sign of chest pain is recommended.
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