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Methamphetamine Cardiotoxicity: Unique Presentation with Multiple Bi-Ventricular Thrombi

https://doi.org/10.1016/j.amjmed.2015.08.006Get rights and content

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Case Presentation

A 35-year-old computer engineer presented with dyspnea and chest pain of 2 weeks duration. He had no coronary artery disease risk factors. He was a well-educated male, nonsmoker, with no history of alcohol use. There was no family history of heart disease. However, he had a long history of methamphetamine abuse for over 15 years. His examination revealed jugular venous distension, bilateral lung crackles, and pedal edema consistent with acute heart failure.

Investigations and Management

Electrocardiogram did not reveal any ischemic changes, and serial troponins were negative, which ruled out an acute coronary syndrome. A computed tomography angiogram of the chest revealed a left-sided pulmonary embolism, and intravenous heparin was commenced. Transthoracic echocardiogram demonstrated severe global hypokinesis of both ventricles, with left ventricular ejection fraction of 23%. Multiple large masses were noted in the left (Figure, Panel A) and right ventricles (Figure, Panel B).

Discussion

Nonischemic cardiomyopathies secondary to drug abuse are increasingly prevalent due to widespread availability of drugs. Homelessness and foster care are well-known risk factors for methamphetamine use.1 It is interesting to note that unlike the typical population in whom drug abuse is prevalent, our patient was a well-educated man with stable employment.

The cardiac manifestations from methamphetamine vary depending on the chronicity of use. Palpitations and cardiac arrhythmias are common

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Funding: None.

Conflict of interest: None.

Authorship: Both authors had access to the data and played a role in writing the manuscript.

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