Kratom-Associated Acute Right Ventricular Dysfunction: Diagnostic and Management Insights

Kratom (Mitragyna speciosa) is a psychoactive herbal supplement with stimulant and opioid-like properties, with emerging reports linking it to cardiovascular toxicity. However, its association with right ventricular (RV) function remains unclear.

We report the case of a 52-year-old man who presented in shock with hypoxia and multiorgan dysfunction. Echocardiography revealed severe RV dilation with McConnell's sign, whereas chest computed tomography angiography ruled out pulmonary embolism. Right heart catheterization confirmed elevated right-sided pressures and high cardiac output consistent with high-output RV failure.

Despite intermittent Kratom use, other etiologies, including thyrotoxicosis, arteriovenous fistula, liver disease, thiamine deficiency, and infection, were systematically excluded. With supportive management, including inotropic therapy, the patient's RV function recovered.

This case emphasizes the importance of recognizing Kratom as a potential factor in unexplained acute RV dysfunction. It highlights the value of prompt echocardiographic and hemodynamic assessment in guiding effective management.