Acute myocardial infarction with multiple coronary thromboses in a young addict of amphetamines and benzodiazepines

Abstract

A 35-year-old man of average build and a smoker, with a background of a psychiatric disorder, was brought by his neighbor to the emergency department after an hour of severe chest pain. Upon arrival at the hospital he had cardiac arrest, was resuscitated, and moved to the catheterization laboratory with inferior, posterior, and lateral myocardial infarction. Coronary angiography showed an unusual thrombosis in multiple coronary branches. Toxicology report showed high levels of amphetamines and benzodiazepines in the patient's original blood sample. The patient was kept under ventilation for 18 days, with difficult recovery due to severe withdrawal manifestations, ventilation acquired pneumonia, and rhabdomyolysis inducing acute renal failure. The patient regained near normal left ventricular function after baseline severe regional and global dysfunction. We postulate a relationship between the use of amphetamines, potentiated by benzodiazepines, and occurrence of acute thrombosis of multiple major coronary arteries.

Keywords: Amphetamines; Benzodiazepine; Coronary; Myocardial infarction; Thrombosis.

Figure 1

Initial electrocardiogram at presentation showing sinus tachycardia with ST-segment elevation in (A) leads II, III, AvF, and V4-V6, with ST-segment depression in V1–V3 and (B) posterior leads ST-segment elevation.

Figure 2

The right coronary angiogram in (A) left anterior oblique projection and (B) left anterior oblique with cranial angulations, both showing patent artery with thrombus (arrows). The insets are zoomed views.

Figure 3

Left coronary angiogram in the right anterior oblique projection shows (A) hazy ostial lesion at the first obtuse marginal branch (arrow), with (B) totally occluded the second obtuse marginal branch and normal left anterior descending artery also confirmed by cranial angulations.

Figure 4

The obtuse marginal (OM) branches (A) after recanalization with balloon and (B) the final result with multiple thrombi in the left circumflex artery (arrows) and distal embolization to the first obtuse marginal branch (arrowhead).