Amphetamine-induced Reverse Takotsubo Cardiomyopathy and Thrombosis: A Case Report

Takotsubo cardiomyopathy is characterized by stress-induced left ventricular dysfunction. The reverse form accounts for < 25% of all cases. We present a case of reverse Takotsubo cardiomyopathy in a young, otherwise healthy, woman following illicit drug use CASE REPORT: A 19-year-old female patient presented to the emergency department (ED) complaining of insomnia, left-sided chest pain, palpitations, and heightened energy levels after ingesting a significant quantity of small, rounded chocolate chips containing unidentified pills at a rave party the previous night. Her electrocardiogram revealed sinus tachycardia with ST-segment elevation in leads I and aVL. At the ED she developed respiratory distress and required oxygen supplementation. Her troponin level was 1.048 nanograms per milliliter (ng/mL) (reference range < 0.03 ng/mL), and her urine drug screen was positive for methamphetamines. Point-of-care transthoracic echocardiography showed moderately impaired left ventricular systolic function (ejection fraction approximately 35-39%) and hypokinesia of basal and mid-left ventricular segments accompanied by hyperkinesia of the apical segments, indicative of reverse Takotsubo cardiomyopathy. The patient was admitted to the cardiac care unit and showed clinical improvement after supportive treatment. However, 30 hours after discharge she presented back to the ED with epigastric pain and was found to have left renal artery thrombosis and an occlusive thrombus at the right internal iliac artery on computed tomography angiography.

Amphetamine intoxication is associated with the development of reverse Takotsubo cardiomyopathy, along with multiple vascular thromboses.