Left Main Spontaneous Coronary Artery Dissection in a Young Woman With Migraine and Triptan Use.

BACKGROUND

Spontaneous coronary artery dissection (SCAD) results from intramural hematoma formation within the coronary arterial wall. It predominantly affects young women and is associated with physical or emotional stress, hormonal influences, and vasoactive medications.

CASE SUMMARY: A 33-year-old woman presented to the emergency department with acute chest pain 1 hour after taking 100 mg of sumatriptan. Electrocardiography demonstrated ST-segment elevation in aVL and diffuse ST-segment depressions. Coronary angiography revealed left main SCAD with thrombosis, treated with thrombectomy and stenting. She developed cardiogenic shock requiring prolonged mechanical circulatory support. Hospitalization course was also complicated by an ischemic stroke and spinal cord infarction. She was stabilized and discharged to rehabilitation.

DISCUSSION: Triptans are associated with coronary vasospasm; their potential role in precipitating SCAD in susceptible individuals remains poorly characterized.

TAKE-HOME MESSAGE: SCAD may occur in patients with migraines even without traditional cardiovascular risk factors and especially after exposure to triptans.