Alcohol and drugs: twins or evil in a young heart.

We describe how the use of multiple drugs and excessive alcohol intake caused a dilated cardiomyopathy complicated by cardiogenic shock and life-threatening ventricular arrhythmias in an otherwise healthy young man. The diagnosis was made by exclusion of other causes of cardiomyopathy. Surprisingly an ischaemic scar without significant coronary artery disease was also found on cardiac MRI, most likely related to vasoactive drugs (cocaine). An ICD was implanted during the same hospital stay after careful assessment of the risk of recurrent ventricular arrhythmias and sudden cardiac death.