Abstract
BackgroundSpontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome with a preponderance for young female patients. Amphetamines are now the second most widely used substance drugs in the world and they are associated with a myriad of cardiac diseases including cardiomyopathies and SCADs. There is much uncertainty regarding the best treatment strategy in such cases and decision-making remains mostly individualized and based on expert opinions.Case presentationA 34-year-old male with an unremarkable past medical history presented to a cardiologist with prominent dyspnea and orthopnea. He reported occasional methamphetamine use from 3 years before the presentation. An echocardiogram showed an enlarged left ventricle and severe systolic dysfunction with an ejection fraction of 10–15%. Coronary angiography revealed multiple linear dissections in both left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). The patient’s right coronary artery (RCA) showed occlusion in the proximal segment. The patient was diagnosed with amphetamine-induced spontaneous coronary artery dissection and resultant ischemic cardiomyopathy. After thorough evaluation, medical treatment ensued.ConclusionsMethamphetamine abusers have a 3.7 fold risk of developing some form of a cardiomyopathy in comparison to individuals without amphetamine abuse. Coronary artery dissection and increased thrombus burden are some of the mechanisms responsible for ischemic cardiomyopathy in these groups of patients.
Highlights
Spontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome with a preponderance for young female patients
Less than 800 cases of SCAD have been reported in literature since 1931 [2] and while most of these reports have focused on SCAD’s acute coronary syndrome (ACS) and sudden cardiac death (SCD) presentations it is obvious that the real numbers are much higher, the reason for this underdiagnose being SCAD’s challenging and often disparate symptoms in young patients with otherwise no coronary artery disease risk factors [3, 4]
We present a 34-year-old male patient with severe dyspnea and multiple coronary dissections on coronary angiogram who was diagnosed with amphetamine-induced SCAD which had resulted in ischemic cardiomyopathy
Summary
SCAD is a condition that is getting more recognized by each passing day, and while most of the attention is directed towards recognizing it in a timely fashion in acute settings, it must be kept in mind that there are chronic cases of SCAD which might lead to cardiovascular symptoms.
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