Adderall induced inverted-Takotsubo cardiomyopathy

Catheter Cardiovasc Interv. 2011 Nov 15;78(6):910-3. doi: 10.1002/ccd.23036. Epub 2011 May 12.

Abstract

Introduction: Takotsubo Cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, was initially described in Japan in 1990. Both illicit and prescription drugs have added to the growing list of insulting stressors. We describe an interesting case of atypical TTC triggered by adderall overdose.

Clinical case: A 19-year-old female was brought to the Emergency Department after ingesting 30 Adderall tablets. She was complaining of pressure like chest pain and shortness of breath. Her cardiac enzymes were elevated but the electrocardiogram was unremarkable. Echocardiography identified an ejection fraction (EF) of 25-30% with severe hypokinesis of the base and a preserved apex. Cardiac angiography demonstrated normal coronary arteries with an EF of 35%, hyperkinetic apex and akinetic base consistent with the diagnosis of inverted-TTC. Her symptoms resolved in 24 hrs. Repeat echocardiogram performed 3 days later showed an EF of 60% with no regional wall motion abnormalities.

Discussion: TTC can be identified as a rapid development of severe and reversible left ventricular dysfunction extending beyond the territory of a single epicardial coronary artery in the absence of coronary artery disease or pheochromocytoma. Clinical presentation can be challenging and very hard to distinguish from acute myocardial infarction. Medication induced-TTC has been reported. In our case, the patient overdosed on Adderall which is a sympathomimetic medication. Cardiac imaging identified wall motion abnormalities consistent with inverted type TTC. Restoration of left ventricular function within days confirms the diagnosis of TTC. In conclusion, this case offers an interesting insight into the pathophysiology of TTC.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amphetamines / adverse effects*
  • Central Nervous System Stimulants / adverse effects*
  • Coronary Angiography
  • Diagnosis, Differential
  • Drug Overdose
  • Echocardiography
  • Female
  • Humans
  • Myocardial Infarction / diagnosis
  • Predictive Value of Tests
  • Recovery of Function
  • Stroke Volume / drug effects*
  • Takotsubo Cardiomyopathy / chemically induced*
  • Takotsubo Cardiomyopathy / diagnosis
  • Takotsubo Cardiomyopathy / physiopathology
  • Takotsubo Cardiomyopathy / therapy
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left / drug effects*

Substances

  • Adderall
  • Amphetamines
  • Central Nervous System Stimulants