Myocardial infarction without obstructive coronary artery disease in a patient taking zolmitriptan. A case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Introduction . Triptans are first-line medications for acute migraine attacks. Their pharmacological action is due to the selective activation of serotonin 5-HT1B/1D receptors, leading to vasoconstriction of cerebral vessels and pain relief. However, a similar vasoconstrictor effect also occurs in the coronary arteries, which specifies their contraindications in patients with coronary artery disease and prior myocardial infarction (MI). Despite this, in individuals without cardiovascular disease, triptans are traditionally considered safe drugs with an extremely low risk of cardiovascular events. Brief description . This is a clinical case of non-obstructive coronary myocardial infarction complicated by transient third-degree atrioventricular block in a 44-year-old patient with no history of cardiovascular disease or risk factors. Ischemic myocardial injury was verified by contrast-enhanced cardiac magnetic resonance imaging, while coronary angiography revealed intact coronary arteries. Taking into account the temporal association and ruling out of alternative causes, coronary vasospasm was considered the most likely mechanism of MI. No recurrence of symptoms or conduction disorders was observed after zolmitriptan discontinuation. Discussion . This case demonstrates a rare complication of zolmitriptan therapy in a patient with no cardiovascular risk factors. Despite the favorable safety profile of triptans, their use, especially at higher doses, can lead to coronary vasospasm and life-threatening complications.
Source: Russian Journal of Cardiology
Institution: Botkin Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7203617645