Triptans and troponin: a case report

Claudia R Weder,Markus Schneemann

doi:10.1186/1750-1172-4-15

Claudia R Weder, Markus Schneemann

Open Access

https://doi.org/10.1186/1750-1172-4-15

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Abstract

This case report describes for the first time acute coronary syndrome in a 67-year old patient after oral intake of naratriptan for migraine. So far in the literature, only sumatriptan, zolmitriptan and frovatriptan have been described to cause acute coronary syndromes.A 67-year old Swiss woman with thoracic pain after intake of 2.5 mg naratriptan presented with T-wave inversions in the ECG and a positive troponin-T at our hospital. Coronary angiography showed normal coronary arteries. Naratriptan-induced coronary vasospasms were thought to have caused the acute coronary syndrome.Triptans should not be prescribed in patients with pre-existing coronary heart disease. However, triptans can also cause acute coronary syndromes in patients without coronary heart disease – as described in our case report. Severe or persistent thoracic pain after intake of triptans should therefore be investigated accordingly.

Highlights

Triptans are an established treatment of acute migraine attacks[1]
Triptans should not be prescribed in patients with pre-existing coronary heart disease
By activating 5HT1B/1D-receptors they lead to vasoconstriction of cerebral blood vessels which are dilated during migraine attacks[2]

Summary

Background

By activating 5HT1B/1D-receptors they lead to vasoconstriction of cerebral blood vessels which are dilated during migraine attacks[2] They reduce secretion of vasoactive peptides and conduction of pain stimuli over the cerebral cortex[2]. We report for the first time acute coronary syndrome in a 67-year old Swiss patient after oral intake of naratriptan for migraine. On the evening before hospital admission the patient suffered from an acute migraine attack with headaches and nausea so that she took 2.5 mg naratriptan orally as usual. As the patient presented with T-wave inversions on the ECG in the first four precordial leads and a positive test for troponin the family doctor sent the patient to our hospital with the diagnosis of an acute coronary syndrome. The patient reported that she did no longer suffer from migraine attacks since taking amlodipine

Discussion

Conclusion

Kelly KM

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