Eletriptan-Associated Coronary Vasospasm in a Heart Transplant Recipient.

BACKGROUND

Triptans are serotonin 5-HT1B/5-HT1D receptor agonists used for migraine treatment that may precipitate coronary vasospasm in susceptible individuals, including heart transplant recipients.

CASE SUMMARY: A 44-year-old woman with orthotopic heart transplantation and cardiac allograft vasculopathy developed acute chest pain shortly after first-dose eletriptan. Electrocardiography demonstrated inferior ST-segment elevation with troponin elevation. Coronary angiography showed severe dynamic narrowing of the right coronary artery with sluggish distal flow despite patent stents. Intracoronary nitroglycerin restored vessel caliber and distal flow, with resolution of chest pain and ST-segment elevation.

DISCUSSION: This case demonstrates acute drug-induced coronary vasospasm following eletriptan use in a heart transplant recipient and highlights the importance of recognizing reversible vasospasm before escalating coronary intervention.

TAKE-HOME MESSAGES: Drug-induced coronary vasospasm should be considered in heart transplant recipients with acute coronary syndrome after exposure to vasoconstrictive medications. Recognition of reversible vasospasm may prevent unnecessary coronary intervention and inappropriate escalation of vasculopathy management.