Amphetamine abuse and acute thrombosis of left circumflex coronary artery

Abstract

Currently, amphetamine abuse is a widespread problem. While the use of recreational drugs is more common in young populations, drug abuse within elderly populations is increasing, though largely unrecognized. The exact nature and dose of recreational drugs are difficult to identify when a patient presents requiring urgent care, notably amphetamine-induced acute coronary syndrome (ACS). A 54-year-old male smoker presented with classical anginal chest pain after using amphetamines. Electrocardiography (ECG) showed T-wave inversion in leads I, aVL, and V4-V6. Laboratory data revealed total creatine kinase (CK) level 1759 IU/L, CK-MB 87 IU/L, and a troponin-I of 13.38 ng/mL. A diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The emergency room physician commenced the NSTEMI protocol, but the patient experienced worsening chest pain unresponsive to nitrates or morphine, with no change in the ECG pattern. The cardiologist decided to proceed with percutaneous coronary intervention. Coronary angiography revealed 100% stenosis in the proximal portion of the left circumflex artery, with a large clot burden. The artery was stented with excellent results. Later testing showed a positive urine toxicology screen for amphetamines. Regardless of the age or gender of the patient, asking questions about stimulant drugs use is crucial with anginal chest pain presentation. Drug abuse is not only for young males but older males and females are also susceptible, and can have unique responses to amphetamine abuse. In this case, amphetamine abuse caused myocardial ischemia due to blood clot formation.