Cardinale Michaël, Esnault Pierre, Schmitt Johan, Meaudre Eric
Department of Anesthesiology and Intensive Care, Hopital d'Instruction des Armees Sainte-Anne, Toulon, France.
Curr Drug Res Rev. 2019;11(2):142-144. doi: 10.2174/2589977511666190716111303.
Cocaine is one of the most widely used illicit drugs, and it is the most common cause of drug-related death. The association of cocaine use with acute heart failure is a rare occurrence.
We report the case of a 31 years-old woman who presented Takotsubo cardiomyopathy with severe cardiogenic shock after cocaine abuse. That required the use of high doses of positive inotropic amines and mechanical ventilation. The evolution was quickly favorable after the cessation of cocaine.
Takotsubo cardiomyopathy is often related to a stressful trigger, and several cases have been described with the use of several psychostimulants. As such, it is not surprising that cocaine use can be associated with the development of Takotsubo cardiomyopathy when it results in excess release of catecholamines and excitation of adrenergic receptors.
In critical care unit, Takotsubo cardiomyopathy is a rare complication of cocaine abuse. This etiological diagnosis can be difficult especially in the absence of the concept of toxic intake as it was initially the case for our patient, but the treatment does not differ from other causes of cardiomyopathy and Cessation of cocaine use has been associated with improvement in cardiac function.
可卡因是使用最为广泛的非法药物之一，也是与药物相关死亡的最常见原因。使用可卡因与急性心力衰竭相关的情况较为罕见。
我们报告一例31岁女性，在滥用可卡因后出现应激性心肌病并伴有严重的心源性休克。这需要使用高剂量的正性肌力胺类药物并进行机械通气。在停止使用可卡因后病情迅速好转。
应激性心肌病通常与应激触发因素有关，已有多例使用多种精神兴奋剂后出现该病的描述。因此，当可卡因使用导致儿茶酚胺过度释放和肾上腺素能受体兴奋时，与应激性心肌病的发生相关也就不足为奇了。
在重症监护病房，应激性心肌病是可卡因滥用的一种罕见并发症。这种病因诊断可能很困难，尤其是在没有药物摄入概念的情况下，就像我们的患者最初那样，但治疗与心肌病的其他病因并无不同，停止使用可卡因与心脏功能改善相关。
