Transient left ventricular apical ballooning after cocaine use: is catecholamine cardiotoxicity the pathologic link?
We describe a patient who developed acute chest pain after using cocaine and had ST-segment elevation in the anterior leads on electrocardiography with mild elevation of cardiac enzymes. Cardiac catheterization showed normal coronary arteries with no coronary vasospasm. Left ventricular angiography revealed typical ballooning of the left ventricular apex during systole with an estimated left ventricular ejection fraction of 25%. The symptoms improved during the next few hours, and follow-up echocardiography 4 days later showed complete resolution of the left ventricular dysfunction. Transient left ventricular apical ballooning (LVAB) was diagnosed. To our knowledge, LVAB (also known as Takotsubo cardiomyopathy or "broken heart syndrome") has not been reported previously in association with cocaine use. We discuss the possible pathophysiologic link between LVAB and cocaine-induced cardiotoxicity.
Arora
Sandeep
S
Department of Internal Medicine, Western Pennsylvania Hospital/Temple University Program, 4800 Friendship Ave, Pittsburgh, PA 15224, USA. sandeeparora24@hotmail.com
Alfayoumi
Fadi
F
Srinivasan
Venkatraman
V
D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*; D002395:Catecholamines / Q000097:blood*; D016578:Crack Cocaine / Q000009:adverse effects* / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*
D002395:Catecholamines; D016578:Crack Cocaine