Vasospasm‐lnduced Myocardial Infarction With Sumatriptan

Abstract

Sumatriptan, a 5-hydroxytryptamine 1 (5-HT 1 ) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56-year-old female patient with migraine who experienced myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.Key words: migraine, sumatriptan, vasospasm, myocardial infarction ( Headache 1996;36:329-331) Sumatriptan, a selective agonist of 5-hydroxytryptamine, (5-HT 1 ) receptors, is an effective migraine abortive agent. 1 Its mechanism of action is thought to be cranial vasoconstriction, mediated by the inhibition of neuroinflammatory peptide release. 2,3 A self-injector unit is available in the United States for subcutaneous administration of 6 mg of sumatriptan as the succinate salt. 2,3 It is believed that most other vascular beds in the body have 5-HT 2 mediated vasoconstriction, and therefore, should not be affected by sumatriptan. 4 Recent studies, however, have found 5-HT 1 -like receptors on coronary arteries. 4-7 A few studies suggest that damaged or atheromatous coronary arteries may be more prone to 5-HT 1 mediated vasoconstriction, 4,5 and the manufacturer has recommended a cardiovascular evaluation prior to sumatriptan use for patients at risk for coronary disease. 3 One study found sumatriptan to act as a full agonist on 5HT 1 -like receptors on normal coronary arteries. 6,7 Coronary vasospasm has been induced by sumatriptan during cardiac catheterization. 4,8 Electrocardiogram changes suggestive of transient ischemia have been reported. 3,9-12 Isolated instances of angina, arrhythmia, myocardial infarction, and death have been reported after administration of sumatriptan. [13][14][15][16][17] It is often difficult to discern whether unsuspected coronary artery disease contributed to adverse cardiac outcomes with sumatriptan. We document the case of a 56-year-old woman who experienced a non-Q wave anterior myocardial infarction temporally related to an injection of sumatriptan for the treatment of a migraine headache. She had a normal routine electrocardiogram and exercise stress test prior to using the medication and a normal cardiac catheterization after the incident. CASE HISTORYA 56-year-old woman was admitted to the hospital after experiencing 5 1/2 hours of severe retrosternal chest pain radiating to her left breast,...

Amplification of sumatriptan-induced contractions with phenylephrine, histamine and KCl in the isolated human mesenteric artery: in-vitro evidence for sumatriptan-induced mesenteric ischaemia

“…5-HT 1B receptors are expressed also in other human vessels such as the mesenteric (Kaumann et al 1993), coronary Connor et al 1989;Toda and Okamura 1990;Borton et al 1990;Kaumann et al 1994) and internal mammary (IMA) (Yildiz et al 1996a(Yildiz et al , 1996b arteries. Sumatriptan reportedly induces chest pain, myocardial ischaemia, coronary vasospasm and myocardial infarction (Hillis and MacIntyre 1993;Kelly 1995;O'Connor and Gladstone 1995;Mueller et al 1996). Recently, it has been reported that sumatriptan induces mesenteric ischaemia and ischaemic colitis in patients (Knudsen et al 1998;Liu et al 2000).…”

A Variant form of Takotsubo Syndrome secondary to Sumatriptan: A case report

“…Cases of transient ischemia, myocardial infarction and arrhythmias have been described with use of 5HT1 receptor agonist [22][23][24] . 5HT1B receptor is known to cause coronary artery spasm and its expression has been demonstrated on coronary artery smooth muscle cell [25,26] .…”

Spontaneous splenic infarction associated with sumatriptan use

“…The major concern with the use of triptans has been the potential for vasoconstriction, especially of the coronary and intracerebral vessels. There are a few case reports of patients developing cardiovascular complications including myocardial infarction, arrhythmias and strokes secondary to use of triptans [1,2]. Isolated cases of mesenteric infarction [9] and a case of spinal cord infarction have also been reported [10].…”