39-year-old man, habitual consumer for long time of cocaine, base paste, marijuana and alcohol; in addition, tobacco and occasionally benzodiazepines; normal weight without other conventional cardiovascular risk factors.
Acquired 1 g of cocaine and 3 g of base paste presented severe back pain.
He was hospitalized for an ante-oseptoapical acute myocardial infarction with medical management, torpid evolution and left ventricular dysfunction.
Coronary angiography performed at 15 days showed ostial occlusion of the anterior descending artery, without collateral circulation.
Cardiac magnetic resonance imaging confirmed transmural anteroseptoapical infarction without evidence of viability, with signs of microvascular obstruction, severe left ventricular (LV) systolic dysfunction.
Treatment was initiated with low molecular weight heparin (LMWH).
No dependence management was achieved by specialists.
Month and a half later he presented left crural brachial hemiparesis, catalogued as a transient ischemic attack and treated on an outpatient basis.
Symptoms decreased partially, ensuring abstinence.
The following month, she was hospitalized due to sudden sweating and hypotension, interpreted as syncope; left central facial paresis of the sequel type was evident with good sensitivity and motility in the four limbs.
Brain computed tomography showed a right frontolenticular insular parenchymal lesion of probable ischemic origin.
High-risk embolic anticoagulation therapy with LMWH was started again.
Due to a new inferior akinesia and ante-oseptoapical thinning, SPECT perfusion imaging with pharmacological stress showed a large fixed defect ante-oseptoapical and inferoapical 60% of the LV with minimal ischemia.
Baseline ECG showed delayed intraventricular conduction.
Subsequently, a submaximal Bruce stress test was performed under beta-blocker, non-conclusive (7 METS), with no angina.
The patient presented mild hypertension dilatation of the left atrium and marked systodiatolic dilatation of the LV, apical akinesia and inferior hypokinesia, moderate dilatation of the right cavities, valve insufficiency and some degree of pulmonary insufficiency.
In the anomaly analysis, there was a significant delay in conduction in the posterior mid-segments, which led to the creation of an automatic mental device, due to an important disturbance of the LV.
1.
In the therapeutic community, better dependence management was achieved.
Heart failure control was included in a heart transplant program.
In summary, a young adult patient, mainly dependent on cocaine and base paste, whose only conventional cardiovascular risk factor was smoking.
She presented three consecutive episodes of coronary and cerebral ischemic events in the short period with severe sequelae (heart failure and facial motor insufficiency); the management of her dependence was late.
