Heart Break or Headache: A Case Report of Sumatriptan-Induced Takotsubo Syndrome

Abstract

Takotsubo syndrome (TS) describes a transient type of dilated cardiomyopathy that mimics acute coronary syndrome (ACS) on initial presentation. Classic TS presents with marked dilation and ballooning of the left ventricular apex with hyperdynamic basal segments. The most frequent etiology is from emotional and stressful triggers; recently, evidence suggests neurologic and psychiatric involvement. There are increasing reports of TS occurring secondary to migraine abortives. We describe a unique case of TS in a woman after taking sumatriptan to abort her headache.

Keywords: broken heart syndrome; headaches; migraines; minoca; myocardial infarction with non-obstructive coronary arteries (minoca); myocardial infarction with nonobstructive coronary arteries; stress induced cardiomyopathy; sumatriptan; takotsubo syndrome; triptans.

Figure 1. Twelve lead electrocardiogram demonstrating lateral T-wave inversion in leads V4-V6

Figure 2. Coronary angiography (PA/CRA) demonstrating no significant coronary disease of the LAD and LCX

PA, postero-anterior; CRA, cranial; LAD, left anterior descending artery; LCX, left circumferential artery

Figure 3. Coronary angiography (RAO/CAU) demonstrating no significant coronary disease of the LAD and LCX

RAO, right anterior oblique; CAU, caudal; LAD, left anterior descending artery; LCX, left circumferential artery

Figure 4. Cardiac angiography (LAO/CAUD) demonstrating no significant coronary disease of the RCA

LAO, left anterior oblique; CAUD, caudal; RCA, right coronary artery

Figure 5. Transthoracic echocardiogram (apical four-chamber view) demonstrating depressed ejection fraction at 40% by Simpson’s method with apical hypokinesis at end-systole

RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium

Figure 6. Left ventriculogram demonstrating apical hypokinesis with basal hyperkinesis

LV, left ventricle; RAO, right anterior oblique; CAUD, caudal