van der Pas RSD, Gresnigt FMJ, Wansink L, Franssen EJF, Riezebos RK. Acute onset heart failure due to reverse type Takotsubo cardiomyopathy caused by a single dose of 4-Fluoroamphetamine in a healthy young individual.
Toxicol Rep 2020;
7:1629-1633. [PMID:
33344175 PMCID:
PMC7736711 DOI:
10.1016/j.toxrep.2020.12.003]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022] Open
Abstract
4-Fluoroamphetamine (4-FA) is a popular new psychoactive stimulant that is used for recreational purposes.
A single dose of 4-FA can lead to reverse type Takotsubo cardiomyopathy with cardiogenic shock.
4-FA use can cause a very sudden onset of severe symptoms.
Due to mild and late onset of effect, 4-FA users have the tendency to take an extra dose.
Phosphodiesterase-3-inhibitors are effective for amphetamine type stimulant induced Takotsubo cardiomyopathy.
Introduction
4-fluoroamphetamine (4-FA) is a novel psychoactive stimulant with a global presence on the drug market. Despite the popularity of 4-FA, data on severe adverse effects are scarce. We present a case of laboratory confirmed 4-FA mono intoxication causing acute heart failure due to a reverse type Takotsubo cardiomyopathy.
Case
A 20-year-old male with no previous medical history and no reported previous drug use, presented to the emergency department (ED) with complaints of headache, nausea and vomiting, approximately 4.5 h after the ingestion of a single 4-FA pill. After 30 min his condition deteriorated with severe hypertension, tachycardia and respiratory failure. Echocardiography showed a reverse type Takotsubo cardiomyopathy. The patient was successfully treated with mechanical ventilation, a phosphodiesterase-3-inhibitor (PDE3-inhibitor) and diuretics. Three months after hospital admission, the patient was free of complaints and his left ventricular function fully recovered.
Conclusion
Recreational use of 4-FA may result in acute onset life-threatening cardiorespiratory toxicity, preceded by severe hypertension, even in drug-naïve patients without any medical history. Emergency physicians and cardiologists should be cautious not to underestimate life-threatening 4-FA complications.
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