https://orcid.org/0000-0002-2702-2731
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Chonthicha Tanking, Varitta Lawsakul, The masquerade of myocardial infarction: methamphetamine-induced reverse Takotsubo syndrome, European Heart Journal - Cardiovascular Imaging, Volume 26, Issue 5, May 2025, Page 941, https://doi.org/10.1093/ehjci/jeaf082
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A 28-year-old female was admitted to the hospital following the onset of typical chest pain that lasted for 15 h. On the preceding day, she attended a social gathering, consumed alcohol, and subsequently awoke experiencing dizziness accompanied by chest pain (pain score 6/10). Her symptoms improved following the administration of nitrates. Upon presentation, her vital signs were as follows: temperature 36.5°C, heart rate 114 beats per minute (regular), blood pressure 83/52 mmHg, and respiratory rate 19 breaths per minute. An electrocardiogram revealed ST-segment depression in leads II, III, aVF, and V4-V6. Serum troponin levels were elevated at 240 ng/L. Coronary angiography indicated normal coronary arteries. Subsequent cardiac magnetic resonance (CMR) revealed an left ventricular ejection fraction (LVEF) of 33%, with hypokinesia of all ventricular segments with preserved contraction of the apical segments (Panels A and B; Supplementary data online, Video S1). Hyperintense signals were observed at the basal and mid-portions on traditional T2-weighted images (Panel C), with increased T2 mapping values at the basal region (73 ms at 3T; Panel D) and normal values at the apex (52 ms at 3T; Panel E). Late gadolinium enhancement imaging did not show any abnormalities (see Supplementary data online, Figure S1). Urine toxicology screening returned a positive result for methamphetamine. Cardiac magnetic resonance 6 weeks later showed normal LVEF with no regional wall abnormality (Panels F and G; Supplementary data online, Video S2). There was resolution of oedema on T2-weighted image and T2 mapping (49 ms at 3T; Panels H–J) at the basal LV segment.
