Acute myocardial infarction with multiple coronary thrombosis in a young multidrug addict (amphetamines, cannabinoids, and tramadol): a case report

Background Our case was acute ST-segment elevation myocardial infarction with multiple coronary thrombosis, despite aggressive anticoagulation and antiplatelet therapy in a young, relatively low-risk patient, on three abused drugs. Case summary A 38-year-old male smoker patient with a BMI of 31 kg/m2 and a background of multiple drug addiction, was admitted after an hour of severe retrosternal compressing chest pain. Upon admission, he had cardiac arrest in ventricular fibrillation. Resuscitation was done, including defibrillation shocks and invasive mechanical ventilation with a cardiopulmonary resuscitation (CPR) time of 17 min and the patient was transferred to the catheterization laboratory with extensive anterior and inferior myocardial infarctions. Coronary angiography showed an unusual thrombosis in multiple coronary branches with coronary spasms and total occlusion of left anterior descending artery for which primary percutaneous coronary intervention was done. Admission laboratory screening showed high blood levels of amphetamines, cannabinoids, and tramadol. The patient was kept under invasive ventilation for 10 days, with difficult weaning due to severe drug-withdrawal manifestations, ventilator-associated pneumonia, and hemodynamic instability that necessitated intravenous inotropic drip and intra-aortic balloon counter pulsation. The patient regained near-normal left ventricular function after baseline severe regional and global dysfunction. Conclusion The authors postulated a relationship between the use of amphetamines, potentiated by cannabinoids and tramadol, and occurrence of acute thrombosis of multiple major coronary arteries especially with concurrent cigarette smoking.