First Reported Case of Khat Cardiomyopathy and Malignant Hypertension in Australia

Abstract

A 37 year old Eritrean migrant presented to our hospital with cardiac failure and malignant hypertension on a background of heavy khat consumption. He had additional cardiac risk factors of morbid obesity and cigarette smoking. There was no other medical history and he took no regular medications. Echocardiography demonstrated a dilated cardiomyopathy with severe biventricular systolic dysfunction (LV ejection fraction 25%) and moderate functional mitral regurgitation. Coronary angiography revealed normal coronary arteries but confirmed severe global left ventricular dysfunction. Our patient commenced appropriate anti-hypertensive and heart failure therapy. Follow-up cardiac MRI within two months of khat cessation demonstrated near-complete recovery, with ejection fraction 48%, mild LV dilation, mildly increased LV wall thickness, and no late gadolinium enhancement to suggest established fibrosis. Khat (Catha edulis) is a leaf with amphetamine-type properties cultivated in East Africa and the Arabian Peninsula since the 7th century. It is estimated there are 20 million users of khat worldwide, with khat-chewing traditionally restricted to men. Documented adverse health effects include psychosis, peptic ulcer disease, hepatitis, cardiomyopathy, accelerated coronary artery disease and malignant hypertension. With increasing migration, khat-related health problems are likely to become more prevalent in Australian healthcare settings. This case underlines the need for doctors caring for East African patients, particularly males, to enquire as to khat consumption as part of comprehensive health screening.