Acute myocardial infarction caused by intravenous amphetamine abuse.

Packe, G E; Garton, Mark; Jennings, K.

doi:10.1136/hrt.64.1.23

Cited by 54 publications

(28 citation statements)

References 17 publications

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“…22 Khat-induced coronary spasm is further supported by the fact that amphetamine, cocaine, and 3,4-methylenedioxymethamphetamine (known as MDMA or ecstasy), which are structurally and/or functionally similar to cathinone, are believed to increase the risk of ACS through the induction of coronary artery spasm. [23][24][25][26][27][28] ACS among khat chewers may also result from the hypercoagulable state. Gebhard et al 29 recently demonstrated the induction of tissue factor with amphetamine, and Steffel et al 30 reported an increase in endothelial tissue factor accompanied by a reduction in tissue factor pathway inhibitor with cocaine.…”

Section: Pathogenesis Of Khat-induced Cardiovascular Complicationsmentioning

confidence: 99%

Acute Coronary Syndrome and Khat Herbal Amphetamine Use

Ali

Habib²,

Al‐Motarreb³

et al. 2011

Circulation

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Background— The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome. Methods and Results— From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment–elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non–khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke. Conclusions— Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing.

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Section: Pathogenesis Of Khat-induced Cardiovascular Complicationsmentioning

confidence: 99%

Acute Coronary Syndrome and Khat Herbal Amphetamine Use

Ali

Habib²,

Al‐Motarreb³

et al. 2011

Circulation

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“…Cases that demonstrated methamphetamine-related disorders were reviewed from both hospital cases and the medical literature. Possible methamphetamine-related ED visits (MREDVs) presented from the medical literature included acute sympathomimetic overdose (e.g., hypertension, tachycardia, hyperthermia, rhabdomyolysis, agitation, seizures), [5][6][7] traumatic injuries, 2,3,8 suicidality, 2,3,9 psychosis, 3,10,11 skin infections, 12 acute coronary syndrome, [13][14][15][16][17][18] skin burns and chemical exposure (from methamphetamine laboratories), 19,20 intracranial hemorrhage and cerebrovascular accident, 21,22 withdrawal symptoms (e.g., fatigue, hypersomnia, anhedonia, anxiety, irritability, dysphoria), 23 and a variety of nonspecific stimulant-related complaints (e.g., headaches, palpitations, anxiety, headache, chest pain). 24 Unique aspects of methamphetamine pathophysiology and outward signs of abuse (e.g., bruxism, repetitive movements, etc.)…”

Section: Study Protocolmentioning

confidence: 99%

Methamphetamine‐related Emergency Department Utilization and Cost

Hendrickson

Cloutier

McConnell

2008

Academic Emergency Medicine

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Objective: To quantify the frequency, cost, and characteristics associated with emergency department (ED) visits that are related to methamphetamine use.Methods: This was a prospective observational study. The authors performed a training program for ED clinicians on the acute and chronic effects of methamphetamine and the signs of methamphetamine abuse. A standardized two question survey was administered to clinicians concerning the relationship between the ED visit and the patient's methamphetamine use. The survey was embedded in the patient tracking system and was required for all ED patients before disposition. Survey results were merged with administrative data on demographics, diagnosis, disposition, and charges. Univariate analyses were used to determine patient characteristics associated with methamphetamine-related ED visits. Results:The authors examined 15,038 ED visits over a 20-week period from February 2006 to June 2006. There were a total of 353 methamphetamine-related visits, for an average of 17.65 visits per week (2.4% of all visits). Hospital charges for methamphetamine-related ED visits averaged $133,181 per week, for an estimated total of $6.9 M in annual charges. Methamphetamine-related ED patients were more likely to be male (odds ratio [OR] 1.6, 95% confidence interval [CI] = 1.30 to 2.01), white (OR 1.8, 95% CI = 1.38 to 2.29), and uninsured (OR 3.2, 95% CI = 2.21 to 4.69). The top four medical conditions associated with methamphetamine-related visits were mental health (18.7%), trauma (18.4%), skin infections (11.1%), and dental diagnoses (9.6%).Conclusions: Methamphetamine abuse accounts for a modest but substantial proportion of ED utilization and hospital cost. Methamphetamine-related ED visits are most commonly related to mental illness, trauma, skin, and dental-related problems.ACADEMIC EMERGENCY MEDICINE 2008; 15:23-31 ª

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“…34 This hypothesis of coronary spasm is further supported by the fact that amphetamine, which is structurally related to cathinone, has been reported by several investigators to cause MI secondary to coronary spasm. [35][36][37][38][39] prognoStic Impact of Khat Chewing Among patientS preSenting with acS To our knowledge, the current study is the first to report in-hospital outcomes of khat chewers presenting with ACS. Khat chewers had significantly higher rates of death, cardiogenic shock, and stroke complications compared with non-khat chewers despite the fact that they had lower cardiovascular risk profiles, including lower prevalence of diabetes and prior cardiovascular disease.…”

mentioning

confidence: 99%

Association of Khat Chewing With Increased Risk of Stroke and Death in Patients Presenting With Acute Coronary Syndrome

Ali

Zubaid

Al‐Motarreb

et al. 2010

Mayo Clinic Proceedings

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Objective: To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS). From January 29, 2007, through July 29, 2007 consecutive patients presenting with ACS were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Patients and MethOds:Results: Of the 8176 study patients, 7242 (88.6%) were nonkhat chewers, and 934 (11.4%) were khat chewers, mainly of Yemeni origin. Khat chewers were older (57 vs 56 years; p=.01) and more likely to be men (85.7% vs 74.5%) compared with non-khat chewers. Non-khat chewers were more likely to have diabetes mellitus, hypertension, dyslipidemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killip class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality. After adjustment of baseline variables, khat chewing was an independent risk factor for in-hospital mortality (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; p<.001) and stroke (odds ratio, 2.7; 95% confidence interval, 1.3-5.9; p=.01).cOnclusiOn: In this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death. In the context of increasing global migration, a greater awareness of potential widespread practices is essential. Mayo

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Acute myocardial infarction caused by intravenous amphetamine abuse.

Cited by 54 publications

References 17 publications

Acute Coronary Syndrome and Khat Herbal Amphetamine Use

Acute Coronary Syndrome and Khat Herbal Amphetamine Use

Methamphetamine‐related Emergency Department Utilization and Cost

Association of Khat Chewing With Increased Risk of Stroke and Death in Patients Presenting With Acute Coronary Syndrome

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