Unique Presentation of Methamphetamine- Induced Cardiomyopathy with Multiple Bilateral Pulmonary Emboli

Methamphetamine is an amphetamine type stimulant that adversely impacts multiple organ systems and is a growing public health problem worldwide. We present a case of a 35-year-old farmer with no previous cardiac history, yet significant history of methamphetamine abuse who experienced worsening shortness of breath, productive cough with hemoptysis, bilateral leg swelling, and orthopnea. Initial laboratory testing were remarkable for mildly elevated levels of troponin, C-reactive protein, beta natriuretic peptide, and D-dimer. Chest radiography revealed cardiomegaly and a small, right-sided pleural effusion. Further diagnostic imaging by computed tomography angiography highlighted bilateral sub-segmental pulmonary embolism (PE) while cardiac echocardiography detected severely dilated cardiomyopathy of all chambers with severely reduced ejection fraction (EF). Additional cardiac and hematological workups were negative for ischemic disease, infection, or thromboembolic disease. The patient was diagnosed with methamphetamine-associated cardiomyopathy (MAC) and PE and treated for new onset heart failure with reduced ejection fraction. Though symptoms improved with cessation of drug use, follow up imaging at two years revealed sustained cardiac damage. MAC can rarely present in association with PE in patients with a history of methamphetamine abuse. A high index of clinical suspicion is necessary to identify this life-threatening combination in young adults.