Top

Published in:

01-12-2021 | Cardiomyopathy

Reverse Takotsubo Cardiomyopathy Precipitated by Chronic Cocaine and Cannabis Use

Authors: Emily Nash, Darren M. Roberts, Nazila Jamshidi

Published in: Cardiovascular Toxicology | Issue 12/2021

Abstract

This case report describes a 31-year-old man with 10 years of cocaine and cannabis dependence who developed reverse Takotsubo cardiomyopathy (rTC), a rare variant of Takotsubo cardiomyopathy. He presented to the Emergency Department (ED) with severe left temporal headache and vomiting which began whilst smoking cannabis and several hours after smoking methamphetamine and using cocaine via insufflation. Computed tomography and angiography of the brain was normal, and the headache resolved with analgesia. Urine drug screen was positive for benzodiazepines, cannabinoids, cocaine, opiates (attributed to morphine administered in ED) and amphetamines. Three hours later he had a seizure and within 10 min developed cardiogenic shock with antero-inferior ST segment depression on electrocardiogram and troponin-T rise to 126 ng/L. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram demonstrated severely impaired left ventricular (LV) systolic function with ejection fraction 15–20% and hypokinesis sparing the apex. Thyrotoxicosis, nutritional, vasculitic, autoimmune and viral screens were negative. Cardiac magnetic resonance imaging demonstrated severe LV functional impairment with dilated and hypocontractile basal segments, and T2 hyperintensity consistent with myocardial oedema and rTC. He received supportive management. Proposed mechanisms of rTC include catecholamine cardiotoxicity and coronary artery vasospasm. In this case, multiple insults including severe headache, cannabis hyperemesis and cocaine and methamphetamine-induced serotonin toxicity culminated in a drug-induced seizure which led to catecholamine cardiotoxicity resulting in rTC. Clinicians should be cognizant of stress cardiomyopathy as a differential diagnosis in patients with substance use disorders.

Lyon, A. R., Bossone, E., Schneider, B., Sechtem, U., Citro, R., Underwood, S. R., Sheppard, M. N., Figtree, G. A., Parodi, G., Akashi, Y. J., Ruschitzka, F., Filippatos, G., Mebazaa, A., & Omerovic, E. (2016). Current state of knowledge on Takotsubo syndrome: A Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 18(1), 8–27. https://doi.org/10.1002/ejhf.424CrossRefPubMed

Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L., Sarcon, A., Geyer, V., Neumann, C. A., Seifert, B., Hellermann, J., Schwyzer, M., Eisenhardt, K., Jenewein, J., Franke, J., Katus, H. A., Burgdorf, C., Schunkert, H., … Lüscher, T. F. (2015). Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. New England Journal of Medicine, 373(10), 929–938. https://doi.org/10.1056/nejmoa1406761

Awad, H. H., McNeal, A. R., & Goyal, H. (2018). Reverse Takotsubo cardiomyopathy: A comprehensive review. Annals of Translational Medicine, 6(23), 460–460. https://doi.org/10.21037/atm.2018.11.08CrossRefPubMedPubMedCentral

Chehab, O., Ioannou, A., Sawhney, A., Rice, A., & Dubrey, S. (2017). Reverse Takotsubo cardiomyopathy and cardiogenic shock associated with methamphetamine consumption. Journal of Emergency Medicine, 53(5), e81–e83. https://doi.org/10.1016/j.jemermed.2017.06.027CrossRef

Ramaraj, R., & Movahed, M. R. (2010). Reverse or inverted Takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congestive Heart Failure, 16(6), 284–286. https://doi.org/10.1111/j.1751-7133.2010.00188.xCrossRefPubMed

Khoueiry, G., Abi Rafeh, N., Azab, B., Markman, E., Waked, A., Abourjaili, G., Shariff, M., & Costantino, T. (2013). Reverse Takotsubo cardiomyopathy in the setting of anaphylaxis treated with high-dose intravenous epinephrine. Journal of Emergency Medicine, 44(1), 96–99. https://doi.org/10.1016/j.jemermed.2011.09.032CrossRef

Esnault, P., Née, L., Signouret, T., Jaussaud, N., & Kerbaul, F. (2014). Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation. Canadian Journal of Anesthesia, 61(12), 1093–1097. https://doi.org/10.1007/s12630-014-0230-xCrossRefPubMed

Belliveau, D., & De, S. (2016). Reverse Takotsubo cardiomyopathy following exogenous epinephrine administration in the early postpartum period. Echocardiography, 33(7), 1089–1091. https://doi.org/10.1111/echo.13219CrossRefPubMed

Chou, J., Beutler, L. R., & Goldschlager, N. (2016). Electrocardiography evolution in a woman presenting with alcohol withdrawal seizures and cocaine use. JAMA Internal Medicine, 176(5), 693–695. https://doi.org/10.1001/jamainternmed.2016.0278CrossRefPubMed

10.

Kyi, H. H., Aljariri Alhesan, N., Upadhaya, S., & Al Hadidi, S. (2017). Seizure associated Takotsubo syndrome: A rare combination. Case Reports in Cardiology, 2017, 1–6. https://doi.org/10.1155/2017/8458054CrossRef

11.

Cotinet, P. A., Bizouarn, P., Roux, F., & Rozec, B. (2021). Management of cardiogenic shock by circulatory support during reverse Tako-Tsubo following amphetamine exposure: A report of two cases. Heart and Lung, 50(3), 465–469. https://doi.org/10.1016/j.hrtlng.2020.10.007CrossRefPubMed

12.

Keituqwa Yanez, I., Nicolas-Franco, S., & Gracia Olivas, J. A. (2017). Heart failure in a case of inverted Takotsubo cardiomyopathy due to cocaine and methamphetamine abuse treated with levosimendan. Archives of Cardiovascular Imaging, 5(1), 1–3. https://doi.org/10.5812/acvi.14401CrossRef

13.

Meera, S., Vallabhaneni, S., & Shirani, J. (2020). Cannabis-induced basal-mid-left ventricular stress cardiomyopathy: A case report. International Journal of Critical Illness and Injury Science, 10(5), 49–52. https://doi.org/10.4103/IJCIIS.IJCIIS_25_20CrossRefPubMedPubMedCentral

14.

Albenque, G., Bohbot, Y., Delpierre, Q., & Tribouilloy, C. (2020). Basal Takotsubo syndrome with transient severe mitral regurgitation caused by drug use: A case report. European Heart Journal—Case Reports, 4(2), 1–6. https://doi.org/10.1093/EHJCR/YTAA028CrossRefPubMedPubMedCentral

15.

Fulcher, J., & Wilcox, I. (2013). Basal stress cardiomyopathy induced by exogenous catecholamines in younger adults. International Journal of Cardiology, 168(6), e158–e160. https://doi.org/10.1016/j.ijcard.2013.08.067CrossRefPubMed

16.

Alsidawi, S., Muth, J., & Wilkin, J. (2011). Adderall induced inverted-Takotsubo cardiomyopathy. Catheterization and Cardiovascular Interventions, 78(6), 910–913. https://doi.org/10.1002/ccd.23036CrossRefPubMed

17.

Al-Abri, S., Meier, K. H., Colby, J. M., Smollin, C. G., & Benowitz, N. L. (2014). Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels. Clinical Toxicology, 52(10), 1292–1295. https://doi.org/10.3109/15563650.2014.974262CrossRefPubMed

18.

Movahed, M. R., & Mostafizi, K. (2008). Reverse or inverted left ventricular apical ballooning syndrome (reverse Takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use. Echocardiography, 25(4), 429–432. https://doi.org/10.1111/j.1540-8175.2007.00604.xCrossRefPubMed

19.

Kaoukis, A., Panagopoulou, V., Mojibian, H. R., & Jacoby, D. (2012). Reverse Takotsubo cardiomyopathy associated with the consumption of an energy drink. Circulation, 125, 1584–1585. https://doi.org/10.1161/CIRCULATIONAHA.111.057505CrossRefPubMed

20.

Dai, Z., Fukuda, T., Kinoshita, K., & Komiyama, N. (2020). Inverted Takotsubo cardiomyopathy associated with the consumption of a weight management supplement. CJC Open, 2(1), 26–29. https://doi.org/10.1016/j.cjco.2019.11.002CrossRefPubMed

21.

Rodriguez-Castro, C. E., Saifuddin, F., Porres-Aguilar, M., Said, S., Gough, D., Siddiqui, T., Mukherjee, D., & Abbas, A. (2015). Reverse Takotsubo cardiomyopathy with use of male enhancers. Proceedings (Baylor University Medical Center), 28(1), 78–80. https://doi.org/10.1080/08998280.2015.11929197CrossRef

22.

Latif, Z., & Garg, N. (2020). The impact of marijuana on the cardiovascular system: A review of the most common cardiovascular events associated with marijuana use. Journal of Clinical Medicine, 9(6), 1–16. https://doi.org/10.3390/jcm9061925CrossRef

23.

Singh, A., Saluja, S., Kumar, A., Agrawal, S., Thind, M., Nanda, S., & Shirani, J. (2018). Cardiovascular complications of marijuana and related substances: A review. Cardiology and Therapy, 7(1), 45–59. https://doi.org/10.1007/s40119-017-0102-xCrossRefPubMed

24.

Maceira, A. M., Ripoll, C., Cosin-Sales, J., Igual, B., Gavilan, M., Salazar, J., Belloch, V., & Pennell, D. J. (2014). Long term effects of cocaine on the heart assessed by cardiovascular magnetic resonance at 3T. Journal of Cardiovascular Magnetic Resonance, 16(1), 1–12. https://doi.org/10.1186/1532-429X-16-26CrossRef

25.

Cooper, C. J., Said, S., Alkhateeb, H., Rodriguez, E., Trien, R., Ajmal, S., Blandon, P. A., & Hernandez, G. T. (2013). Dilated cardiomyopathy secondary to chronic cocaine abuse: A case report. BMC Research Notes, 6(536), 1–4. https://doi.org/10.1186/1756-0500-6-536CrossRef

26.

Zacà, V., Lunghetti, S., Ballo, P., Focardi, M., Favilli, R., & Mondillo, S. (2007). Recovery from cardiomyopathy after abstinence from cocaine. Lancet, 369(9572), 1574. https://doi.org/10.1016/S0140-6736(07)60711-9CrossRefPubMed

27.

Vasica, G., & Tennant, C. C. (2002). Cocaine use and cardiovascular complications. Medical Journal of Australia, 177(5), 260–262. https://doi.org/10.5694/j.1326-5377.2002.tb04761.xCrossRef

28.

Naranjo, C. A., Busto, U., Sellers, E. M., Sandor, P., Ruiz, I., Roberts, E. A., Janecek, E., Domecq, C., & Greenblatt, D. J. (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology & Therapeutics, 30(2), 239–245.CrossRef

29.

Paur, H., Wright, P. T., Sikkel, M. B., Tranter, M. H., Mansfield, C., O’Gara, P., Stuckey, D. J., Nikolaev, V. O., Diakonov, I., Pannell, L., Gong, H., Sun, H., Peters, N. S., Petrou, M., Zheng, Z., Gorelik, J., Lyon, A. R., & Harding, S. E. (2012). High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: A new model of Takotsubo cardiomyopathy. Circulation, 126(6), 697–706. https://doi.org/10.1161/CIRCULATIONAHA.112.111591CrossRefPubMedPubMedCentral

30.

Abe, Y., Tamura, A., & Kadota, J. (2010). Prolonged cardiogenic shock caused by a high-dose intravenous administration of dopamine in a patient with Takotsubo cardiomyopathy. International Journal of Cardiology, 141(1), e1–e3. https://doi.org/10.1016/j.ijcard.2008.11.123CrossRefPubMed

31.

Abraham, J., Mudd, J. O., Kapur, N., Klein, K., Champion, H. C., & Wittstein, I. S. (2009). Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. Journal of the American College of Cardiology, 53(15), 1320–1325. https://doi.org/10.1016/j.jacc.2009.02.020CrossRefPubMed

32.

Arias, A. M., Oberti, P. F., Pizarro, R., Falconi, M. L., Pérez De Arenaza, D., Zeffiro, S., & Cagide, A. M. (2011). Dobutamine-precipitated Takotsubo cardiomyopathy mimicking acute myocardial infarction: A multimodality image approach. Circulation, 124, e312–e315. https://doi.org/10.1161/CIRCULATIONAHA.110.008557CrossRefPubMed

33.

Mosley, W. J., Manuchehry, A., McEvoy, C., & Rigolin, V. (2010). Takotsubo cardiomyopathy induced by dobutamine infusion: A new phenomenon or an old disease with a new name. Echocardiography, 27(3), e30–e33. https://doi.org/10.1111/j.1540-8175.2009.01089.xCrossRefPubMed

Title: Reverse Takotsubo Cardiomyopathy Precipitated by Chronic Cocaine and Cannabis Use
Authors: Emily Nash
Darren M. Roberts
Nazila Jamshidi
Publication date: 01-12-2021
Publisher: Springer US
Keyword: Cardiomyopathy
Published in: Cardiovascular Toxicology / Issue 12/2021
Print ISSN: 1530-7905
Electronic ISSN: 1559-0259
DOI: https://doi.org/10.1007/s12012-021-09692-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Reverse Takotsubo Cardiomyopathy Precipitated by Chronic Cocaine and Cannabis Use

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2021

Effects of Controlled Generator Fume Emissions on the Levels of Troponin I, C-Reactive Protein and Oxidative Stress Markers in Dogs: Exploring Air Pollution-Induced Cardiovascular Disease in a Low-Resource Country

HIV Tat Protein Induces Myocardial Fibrosis Through TGF-β1-CTGF Signaling Cascade: A Potential Mechanism of HIV Infection-Related Cardiac Manifestations

Dose-Dependent Cardioprotective Effect of Hemin in Doxorubicin-Induced Cardiotoxicity Via Nrf-2/HO-1 and TLR-5/NF-κB/TNF-α Signaling Pathways

Astaxanthin Ameliorates Blood Pressure in Salt-Induced Prehypertensive Rats Through ROS/MAPK/NF-κB Pathways in the Hypothalamic Paraventricular Nucleus

Anti-hyperlipidemic, Anti-inflammatory, and Ameliorative Effects of DRP1 Inhibition in Rats with Experimentally Induced Myocardial Infarction

DNMT1-Induced miR-152-3p Suppression Facilitates Cardiac Fibroblast Activation in Cardiac Fibrosis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page