Acute myocardial infarction secondary to catecholamine release owing to cocaine abuse and pheochromocytoma crisis.

Most pheochromocytomas are not suspected clinically while a high percentage of them are curable with surgery. We present the case of an adult cocaine-addicted male patient with an underlying pheochromocytoma and repeated myocardial infarctions. Computed tomography showed a left round adrenal mass, also high 24-hour urine levels of catecholamines and metanephrines were detected from urinalysis. The patient was given alpha and beta blockers, moreover a laparoscopic left adrenalectomy was performed. Cocaine can block the reuptake of noradrenaline, leading to increasing its concentration and consequently its effects as well, and induce local or diffuse coronary vasoconstriction in normal coronary artery segments per se, cocaine can also trigger pheochromocytoma crisis, and therefore, cardiac complications such as myocardial infarction due to these additive effects are intended to occur. For this reason, in the presence of typical clinical manifestations of pheochromocytoma, such as sustained or paroxysmal hypertension, headache, sweating, tachycardia and abdominal pain, probable association of this tumor in patients with cocaine abuse and associated cardiac complications must be ruled out.

[Myocardial necrosis and severe biventricular dysfunction in the context of chronic ephedrine abuse]. / Necrosis miocárdica y disfunción biventricular severa en el contexto de abuso crónico de efedrina.

Ephedra is an amphetamine-like compound with a potent sympathomimetic effect. Ephedrine, its active component, is widely used for weight loss, to enhance athletic performance or as component of some drugs. Its cardiovascular effects include tachycardia, increased inotropy, arterial vasoconstriction and hypertension, and these are the effects for which it is used therapeutically. However, it can also cause adverse effects, such as neuropathy, myopathy, psychosis, addiction, stroke, insomnia, myocarditis, arrhythmias, myocardial infarction or sudden death. We present the case of a patient, with pre-existing psychiatric conditions, who developed congestive heart failure and pulmonary oedema in the context of severe biventricular dysfunction and myocardial necrosis secondary to longstanding ephedrine abuse. Secondary causes of dilated myocardiopathy such as alcohol abuse, autoimmunity, hemochromatosis, thyroid alterations, viral or bacterial myocarditis and coronary heart disease, were ruled out. Five years after total cessation of use of the drug containing ephedrine, the patient is symptom-free, with partial recovery of left ventricular ejection fraction.

Necrosis miocárdica y disfunción biventricular severa en el contexto de abuso crónico de efedrina / Myocardial necrosis and severe biventricular dysfunction in the context of chronic ephedrine abuse

La efedra es un compuesto similar a la anfetamina con un potente efecto simpaticomimético. La efedrina, su componente activo, es usado ampliamente para reducir peso, mejorar la forma atlética o como componente de algunos fármacos. Los efectos cardiovasculares de la efedrina incluyen taquicardia, aumento de la contractilidad miocárdica, vasoconstricción arterial e hipertensión arterial, efectos por los que suele ser usada terapéuticamente. Sin embargo, también puede producir efectos adversos tales como neuropatía, miopatía, psicosis, adicción, accidentes cerebrovasculares, insomnio, miocarditis, arritmias, infarto de miocardio o muerte súbita. Presentamos el caso de un paciente con antecedentes psiquiátricos, que desarrolló fallo cardiaco congestivo y edema agudo de pulmón en el contexto de disfunción biventricular severa y necrosis miocárdica secundaria a abuso crónico de efedrina. Otras causas de miocardiopatía dilatada, tales como alcoholismo, autoinmunidad, hemocromatosis, alteraciones tiroideas, miocarditis bacteriana o viral y enfermedad arterial coronaria fueron descartadas. Tras cinco años de abandono total del fármaco, el paciente se encuentra libre de síntomas con recuperación parcial de la fracción de eyección ventricular izquierda (AU)

Ephedra is an amphetamine-like compound with a potent sympathomimetic effect. Ephedrine, its active component, is widely used for weight loss, to enhance athletic performance or as component of some drugs. Its cardiovascular effects include tachycardia, increased inotropy, arterial vasoconstriction and hypertension, and these are the effects for which it is used therapeutically. However, it can also cause adverse effects, such as neuropathy, myopathy, psychosis, addiction, stroke, insomnia, myocarditis, arrhythmias, myocardial infarction or sudden death. We present the case of a patient, with pre-existing psychiatric conditions, who developed congestive heart failure and pulmonary oedema in the context of severe biventricular dysfunction and myocardial necrosis secondary to longstanding ephedrine abuse. Secondary causes of dilated myocardiopathy such as alcohol abuse, autoimmunity, hemochromatosis, thyroid alterations, viral or bacterial myocarditis and coronary heart disease, were ruled out. Five years after total cessation of use of the drug containing ephedrine, the patient is symptom-free, with partial recovery of left ventricular ejection fraction (AU)

Biomarcadores en los síndromes coronarios agudos con y sin elevación del ST / Biomarkers in acute coronary syndromes with and without ST elevation

Introducción y objetivos. En el síndrome coronario agudo se produce un fenómeno inflamatorio con alteración de diversos marcadores analíticos. Su conocimiento podría ayudarnos a estratificar mejor el riesgo y a elegir el tratamiento más adecuado. Métodos. Se estudió a 151 pacientes consecutivos ingresados con síndrome coronario agudo sin elevación del ST (SCASEST) y síndrome coronario agudo con elevación del ST (SCACEST). Se determinaron los factores de riesgo cardiovascular clásicos (diabetes mellitus, hipertensión arterial, hipercolesterolemia, antecedentes familiares y personales de cardiopatía isquémica y tabaquismo) y diversos marcadores analíticos entre los que se incluyeron la insulinemia, el fibrinógeno, la proteína C reactiva, la lipoproteína (a) y la velocidad de sedimentación globular. Resultados. Del total de pacientes, 88 (58,3%) presentaron SCASEST y 63 (41,7%), SCACEST. Los pacientes con SCASEST tuvieron de forma significativa una incidencia mayor de diabetes mellitus y de antecedentes personales de cardiopatía isquémica que los que presentaron SCACEST. En los pacientes con SCACEST se obtuvieron de forma significativa cifras más elevadas de fibrinógeno, proteína C reactiva, transaminasa glutamicoxalacética y transaminasa glutámico pirúvica. El análisis multivariante mostró que la diabetes mellitus y los antecedentes personales eran más frecuentes en pacientes con SCASEST, mientras que los valores de fibrinógeno eran más elevados en pacientes con SCACEST. Conclusiones. Los pacientes diabéticos y con antecedentes personales de cardiopatía isquémica presentaron SCASEST de forma más frecuente. De los parámetros estudiados, el fibrinógeno se encontró de forma significativa más elevado en los pacientes con SCACEST (AU)

Introduction and objectives. Acute coronary syndrome involves an inflammatory process which has several analytical markers. Knowledge of those could help us improve the risk classification and choose the most appropriate treatment. Methods. A total of 151 consecutive patients with STE-ACS and NSTE-ACS (ST elevated and non-ST elevated acute coronary syndrome) were studied. The classic cardiovascular risk factors (diabetes mellitus, high blood pressure, family and personal history and smoking habits) were determined along with several analytical markers, among which were included insulin, fibrinogen, C-reactive protein, Lp(a) and erythrocyte sedimentation rate. Results. Of the total pateints, 88 (58.3%) had NSTE-ACS and 63 (41.7%) with STE-ACS . Patients with NSTE-ACS had a significantly higher incidence of diabetes mellitus and personal history of ischaemic heart disease than those who had a STE-ACS. Significantly higher levels of fibrinogen, C-reactive protein, GoT and GPT were obtained in patients with STE-ACS. The multivariate analysis showed that diabetes mellitus and a personal history were more frequent in NSTE-ACS, while fibrinogen levels were higher in those who had STE-ACS. Conclusions. NSTE-ACS is more frequent in patients with diabetes and those with a personal history of ischaemic heart disease. Of the parameters studied, fibrinogen was found to be significantly higher in patients with STE-ACS (AU)