Pułapki diagnostyczne zawału mięśnia sercowego typu drugiego spowodowanego stosowaniem kokainy

Abstract

Introduction. Results of cocaine intake can be such cardiovascular complications as hypertension, myocardial infarction, arrhythmia, and cardiomyopathy. Anabolic androgenic steroids use is related to hypertension, cardiomyopathy and lipid metabolism derangements.Case report. On admission to the cardiology department a 37-year-old man presented prolonged pain at rest located in the middle part of the chest, which occurred 2 days earlier. He was after the use of cocaine, tetrahydrocannabinol, and alcohol. Smoking and using the growth hormone and anabolic androgenic steroids (AAS) in the past were present in the patient's medical history. Physical examination with no deviation, heart rate 72/min, and blood pressure 130/90 mm Hg. Features of anterior wall myocardial infarction (MI) were present in electrocardiogram -ST-elevation up to 3 mm in V2-V5. In laboratory tests, troponin T rise (1.99 ng/mL) and D-dimer (503 ng/mL) were observed. In echocardiography -apex hypokinesis and concentric left ventricular hypertrophy -max. thickness: 19 mm. No significant abnormalities were detected in an immediate coronary angiography. Heart damage of vascular aetiology involving an apical region and partial interventricular septum were confirmed in magnetic resonance imaging. No significant arrhythmias are present in electrocardiogram Holter monitoring. Conservative treatment was prescribed: beta blockers, atorvastatin, enoxaparin, captopril, acetyl salicylic acid (ASA), electrolytes i.v. and was released from hospital after 4 days. On discharge in a good general condition with a recommended further treatment.Conclusions. The presented case is an example of ST-elevation myocardial infarction (STEMI) in a young patient with left ventricular hypertrophy of multifactorial aetiology (hypertrophic cardiomyopathy, athlete's heart, hypertrophy due to anabolic steroids, and growth hormone intake). Immediate coronary angiography showed no significant abnormalities. The patient during STEMI was after ingestion of cocaine and other stimulants which, apart from pulmonary embolism, vasospastic angina, and Takotsubo cardiomyopathy, can be an aetiology factor. Elimination of all modifiable risk factors is the key factor influencing successful therapy in this case.