Severe coronary artery spasm after administration of a 5-hydroxytryptamine type 1 receptor agonist in a patient with new-onset Graves’ disease and myocarditis after SARS-CoV2 vaccination

Abstract

Background

Coronary artery spasm is a well-known potential side effect of selective 5-hydroxytryptamine type 1 (5HT1) receptor agonists and, therefore, contraindicated in patients with cardiovascular disease. SARS-CoV-2 vaccination has been associated with myocarditis, mainly in young men.

Case summary

A 55-year-old man with longstanding cluster headache, treated with the 5HT1-agonist Sumatriptan for ten years, received the mRNA-1273 SARS-CoV-2 booster vaccine. Four days later, he developed severe retrosternal pain several minutes after administering Sumatriptan with electrographic ST-elevation and a raised high-sensitivity cardiac troponin-T (hs-cTnT). Coronary angiogram was normal, but a diagnosis of acute myocarditis and hyperthyroidism secondary to Graves’ disease was made.

Discussion

We present a case of severe coronary artery spasm induced by a 5HT1-agonist secondary to newly diagnosed Graves’ disease and myocarditis. The mRNA-1273 SARS-CoV-2 booster vaccine administered four days before admission probably triggered both immunoreactions.

Keywords:

• Coronary artery spasm
• ST-elevation
• selective 5-hydroxytryptamine type 1 receptor agonist
• myocarditis
• Graves' disease
• SARS-CoV-2 vaccination

Acknowledgements

First, we like to thank Dr. Yves Kockaerts (Department of Endocrinology, Hospital Oost-Limburg, Genk, Belgium) for his guidance in diagnosis and therapy regarding patients' Graves' disease. Second, Dr. Erwin Vanrooses' (Department of Neurology, Hospital Oost-Limburg, Genk, Belgium) expertise concerning the complex treatment of patients cluster headache attacks was very meaningful in the whole process.

Disclosure statement

No potential conflict of interest was reported by the author(s).