Adderall induced inverted-Takotsubo cardiomyopathy.

Area of Science:

• Cardiology
• Pharmacology
• Toxicology

Background:

• Takotsubo Cardiomyopathy (TTC), or stress-induced cardiomyopathy, is a condition characterized by acute left ventricular dysfunction.
• While often associated with emotional or physical stress, drug-induced cases are increasingly recognized.
• Adderall (amphetamine and dextroamphetamine) is a sympathomimetic stimulant with potential cardiovascular effects.

Observation:

• A 19-year-old female presented with chest pain and shortness of breath after ingesting 30 Adderall tablets.
• Initial ECG was unremarkable, but echocardiography revealed severely reduced ejection fraction (25-30%) with basal hypokinesis and apical sparing.
• Cardiac angiography showed normal coronary arteries and confirmed inverted Takotsubo Cardiomyopathy (TTC) with basal akinesis and hyperdynamic apex.

Findings:

• The patient's symptoms resolved within 24 hours, and left ventricular function normalized (EF 60%) within 3 days.
• This rapid recovery of cardiac function is characteristic of TTC.
• The case demonstrates an atypical, inverted pattern of TTC induced by an Adderall overdose.

Implications:

• This case underscores the potential for sympathomimetic medications like Adderall to induce TTC.
• Distinguishing drug-induced TTC from acute myocardial infarction is crucial for appropriate management.
• Understanding the pathophysiology of TTC, particularly in drug-induced scenarios, is essential for clinical practice.