Sivagnanam Kamesh, Chaudari Dhara, Lopez Pablo, Sutherland Michael E, Ramu Vijay K
Department of Internal Medicine, East Tennessee State University, Johnson City, TN, U.S.A.
Am J Case Rep. 2013 Jul 31;14:288-91. doi: 10.12659/AJCR.889381. Print 2013.
Male, 27 FINAL DIAGNOSIS: Bath salt induced cardiomyopathy Symptoms: Agitation • fever • pedal edema
Intravenous nor-epinephrine for less than 6 hours Clinical Procedure: - Specialty: Internal medicine • cardiology.
Unusual clinical course.
"Bath salts" is the street name for a group of recently identified and increasingly abused stimulant synthetic cathinones that are associated with multiple systemic effects. We present a case of a patient who developed reversible dilated cardiomyopathy secondary to their use.
A 27 year old male with no past medical history was brought to emergency department with agitation. He had been inhaling and intravenously injecting "bath salts", containing a mephedrone/Methylenedioxypyrovalerone (MDPV) combination. On presentation, he was tachycardic, hypotensive and febrile. His initial labs showed an elevated white count, creatinine and creatinine phosphokinase levels. His erythrocyte sedimentation rate; C-reactive protein; urinalysis; urine drug screen; Human Immunodeficiency Virus, hepatitis, coxsackie, and influenza serology were normal. EKG showed sinus tachycardia. An echocardiogram was done which showed dilated cardiomyopathy with an ejection fraction (EF) of 15-20% and global hypokinesia. A left heart catheterization was done and was negative for coronary artery disease. At a 20 week follow up, he had stopped abusing bath salts and was asymptomatic. A repeat echocardiogram showed an EF of 52%.
Bath salts (MDPV, mephedrone) are synthetic cathinones with amphetamine/cocaine like properties with potential cardiotoxic effects. Cardiovascular manifestations reported include tachycardia, hypertension, myocardial infarction, arrhythmias and cardiac arrest. "Bath salts" can also cause severe reversible dilated cardiomyopathy. Prior to diagnosis, other causes of cardiomyopathy including ischemic, infectious, familial, immunological, metabolic and cytotoxic may need to be ruled out; as was done in our patient.
男性，27岁
浴盐所致心肌病
烦躁不安、发热、足部水肿
静脉注射去甲肾上腺素不足6小时
不寻常的临床病程
“浴盐”是一类最近被发现且滥用情况日益增多的刺激性合成卡西酮的俗称，与多种全身效应有关。我们报告一例因使用浴盐继发可逆性扩张型心肌病的患者。
一名无既往病史的27岁男性因烦躁不安被送至急诊科。他一直在吸入和静脉注射含有甲氧麻黄酮/亚甲二氧基吡咯戊酮（MDPV）组合的“浴盐”。就诊时，他心动过速、血压过低且发热。其初始实验室检查显示白细胞、肌酐和肌酸磷酸激酶水平升高。他的红细胞沉降率、C反应蛋白、尿液分析、尿液药物筛查、人类免疫缺陷病毒、肝炎、柯萨奇病毒和流感血清学检查均正常。心电图显示窦性心动过速。进行了超声心动图检查，结果显示为扩张型心肌病，射血分数（EF）为15% - 20%，整体运动减弱。进行了左心导管插入术，结果显示冠状动脉疾病呈阴性。在20周的随访中，他已停止滥用浴盐且无症状。再次进行超声心动图检查显示射血分数为52%。
浴盐（MDPV、甲氧麻黄酮）是具有苯丙胺/可卡因样特性且具有潜在心脏毒性作用的合成卡西酮。报告的心血管表现包括心动过速、高血压、心肌梗死、心律失常和心脏骤停。“浴盐”还可导致严重的可逆性扩张型心肌病。在诊断之前，可能需要排除心肌病的其他病因，包括缺血性、感染性、家族性、免疫性、代谢性和细胞毒性病因；就像我们的患者那样。
