Acute Left Ventricular Failure in Cocaine Abused Young Patient: Case Report

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DOI: 10.21522/TIJMD.2013.04.01.Art002

Authors : Naresh Sen, Sonal Tanwar


Background: Cocaine is responsible for LV systolic dysfunction in patients (long-term users or with acute intoxication). The mechanism leading to develop cocaine-induced cardiomyopathy is not completely understood, however development of a coronary thrombus, increased oxidative stress, calcium flux sympathomimetic effects are contributing factors in its pathophysiologic formation.

Case Report: A 23 year old B.Tech third year student from top of north India was admitted in cardiac emergency department with complaint of severe breathlessness and pink frothy sputum. ECG showed sinus tachycardia, hyperacute T waves without any ST elevation and depression or T wave inversion. He denied previous history of hypertension, diabetes, thyroid, asthma or tuberculosis and trauma or surgery. He stated us his personal history about cocaine abuser almost 7 years 6 to 8 times per month. On examination he was hypertensive and tachycardic with low Oxygen saturation (70%). Lab data showed an elevated Brain natriuretic peptide; urine toxicology was positive for cocaine. 2D-echocardiography showed dilated left ventricle with poor LV systolic function LVEF-30%. Coronary angiography revealed LAD spasm without any obstructive lesions, subsequently NTG infusion was given and final result was TIMI 3 flow in coronaries. He was managed medically and subsequently discharged with drug rehabilitation. On follow-up diagnostic evaluation after 6 months of cocaine cessation, his ejection function improved significantly.

Conclusion: Cocaine is a potent sympathomimetic agent associated with the development of possible fatal cardiovascular complications. Hypertension, Dilated cardiomyopathy, Dysrhythmias and Acute myocardial infarction are just some of many cardiovascular effects related to the abuse of cocaine. The management is like other forms of cardiomyopathy; however β-blockers should be avoided. Non-invasive testing should be performed after several months to re-evaluate the treatment response.

Keywords: Cocaine, Left Ventricle Systolic dysfunction, Heart Failure


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