Methamphetamine-associated acute myocardial infarction and cardiogenic shock with normal coronary arteries: refractory global coronary microvascular spasm.
Methamphetamine (MET) is a growing public health concern and is prevalent in, although not limited to, the youth. The drug's association with myocardial infarction is well described and is attributed to accelerated atherosclerosis, hypercoagulable state, and macrovascular epicardial coronary spasm. However, global slow-flow of all coronary systems in the absence of significant stenoses has not been previously reported. We hereby present a young patient who likely experienced severe, global microvascular coronary spasm unrelieved by intracoronary vasodilator therapy, resulting in acute myocardial infarction. The pharmacology of MET, its postulated mechanism in acute coronary syndromes, as well as the pathophysiology and treatments of microvascular coronary spasm are briefly reviewed. Readers are recommended to be vigilant of potential illicit drug use in patients with atypical presentations of acute coronary syndromes.
Chen
Jack P
JP
Department of Cardiology, Saint Joseph's Hospital of Atlanta, Atlanta, GA, USA. chenjackapollo@yahoo.com
D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000000981:diagnostic imaging; D018450:Disease Progression; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis; D012770:Shock, Cardiogenic / Q000139:chemically induced*
D000697:Central Nervous System Stimulants; D008694:Methamphetamine