Acute Left Ventricular Failure in Cocaine Abused Young Patient: Case Report
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.
Left Ventricle Systolic dysfunction, Heart Failure
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