Publication Date
3-1-2023
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-21-7604
PMID
37043755
Publication Date(s)
March 2023
Language
English
PMCID
PMC10178650
PubMedCentral® Posted Date
4-12-2023
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Female, Humans, Adult, Takotsubo Cardiomyopathy, Heroin, Heroin Dependence, Buprenorphine, Naloxone Drug Combination, Electrocardiography
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Reverse takotsubo cardiomyopathy is triggered by emotional or physical stress and has a presentation similar to that of acute coronary syndrome. A 39-year-old woman with a history of heroin use disorder presented with intractable nausea, vomiting, and diarrhea. She was diagnosed with heroin withdrawal and started on buprenorphine-naloxone. On day 2 of her hospitalization, she developed chest heaviness and had an elevated troponin I level of 3.2 ng/mL (reference range, 0.015-0.045 ng/mL); electrocardiography showed new T-wave inversions in the anterior and inferior leads. Emergent coronary angiography showed patent coronary arteries, and left ventriculography showed basal hypokinesis and apical hyperkinesis, consistent with reverse takotsubo cardiomyopathy secondary to heroin withdrawal. She was started on antihypertensive agents, and her buprenorphine-naloxone dose was increased. At her 3-month follow-up visit, she reported no symptoms consistent with angina or heart failure. This appears to be the first report of heroin withdrawal causing reverse takotsubo cardiomyopathy. Awareness of this association can lead to earlier recognition and treatment of reverse takotsubo cardiomyopathy.