Acute myocardial infarction with e-cigarette or vaping-use associated lung injury in a young Filipino vape user

Abstract

Electronic cigarettes (or e-cigarettes) and vape products have multisystemic adverse effects despite being advertised as a safer smoking alternative and cessation device. We present a 22-year-old Filipino male with sudden chest pain. He had no known comorbidities but had a two-year history of daily vape use. Work-up revealed elevated cardiac markers, anteroseptal ST-elevation myocardial infarction, hypokinesia of the anterior wall and interventricular septum, and an ejection fraction of 30%. Chest radiography showed consolidation pneumonia but culture studies and Biofire Pneumonia Panel were negative for microbial detection. Coronary angiography revealed chronic total obstruction of the mid-left anterior descending (LAD) and right coronary arteries (RCA). Percutaneous coronary angioplasty of the LAD was done. The patient eventually required mechanical ventilation for progressive respiratory distress but expired after three hospital days despite medical management. This case highlights a possible association between vape use and the development of both acute lung injury and myocardial infarction.

Keywords: E‐cigarette or vape use associated lung injury; acute myocardial infarction.

FIGURE 1

Cranial projection images showing pre (left) and post (right) percutaneous coronary angiography with reconstruction of LAD flow. Red circle on the left image denotes a blunt stump indicative of chronic total obstruction and larger red circle in the right images shows well deployed stent at the proximal to mid LAD.

FIGURE 2

Chest computed tomography lung window axial view. (A) Extensive consolidation, (B) patches of ground glass opacities with septal thickening, (C) crazy paving pattern with peripheral distribution, and (D) extensive pneumomediastinum with pneumopericardium.