Sumatriptan Induced Takotsubo Cardiomyopathy: A Headache of the Heart

Takotsubo cardiomyopathy (TCM) is a condition that causes temporary weakening of the heart muscle, resulting in chest pain, shortness of breath, and abnormal heart rhythms. It is also known as stress-induced cardiomyopathy, broken heart syndrome, or apical ballooning syndrome, because it often occurs after a stressful event and resembles the shape of a Japanese octopus trap.

TCM is usually triggered by a surge of adrenaline or other stress hormones that affect the heart's function. However, some medications can also cause or worsen TCM, such as sumatriptan, a drug used to treat migraines. Sumatriptan belongs to a class of drugs called triptans, which work by narrowing the blood vessels in the brain to relieve headache pain. However, sumatriptan can also constrict the coronary arteries, reducing blood flow to the heart and causing ischemia.

There have been several case reports of sumatriptan-induced TCM in the medical literature, mostly in women with a history of migraines. The symptoms usually occur within minutes to hours of taking the drug, and can mimic a heart attack. The diagnosis is confirmed by ruling out obstructive coronary artery disease and showing the characteristic pattern of left ventricular dysfunction on echocardiography or angiography.

The treatment of sumatriptan-induced TCM is similar to that of other forms of TCM, which involves supportive care, symptom relief, and prevention of complications. Beta-blockers, such as metoprolol, can help reduce the effects of adrenaline on the heart and improve the recovery of the heart function. Patients with sumatriptan-induced TCM should also avoid taking triptans or other vasoconstrictors in the future, as they may increase the risk of recurrence.

Sumatriptan-induced TCM is a rare but serious complication of migraine therapy that can be life-threatening if not recognized and treated promptly. Patients with migraines should be aware of this potential side effect and seek medical attention if they experience chest pain or other signs of cardiac distress after taking sumatriptan or other triptans.