Year: 2021
Type: conference-abstract
Abstract: We present an adolescent with newly diagnosed hypertrophic cardiomyopathy who suffered cardiac arrest with ventricular fibrillation. We assume these conditions could have been caused by substances commonly abused by adolescents: anabolic steroids and synthetic cannabinoids Previously healthy, muscular, seventeen-year-old adolescent was examined by a paediatric cardiologist because of chest pain. Asymmetric hypertrophic cardiomyopathy without outflow tract obstruction was diagnosed, with sinus rhythm in 24 hour holter electrocardiogram. Avoidance of sport activities and bisoprolol therapy was suggested, which the patient did not comply to. There were no heart diseases in the family history. Four months after, the patient suddenly collapsed while sitting. Resuscitation was started immediately and defibrillation was used because of ventricular fibrillation. Patient was transferred to the hospital. After additional 80 minutes of resuscitation with recurring ventricular fibrillation, a stable pulse was regained. Since the hemodynamic stability was not achieved with high catecholamine doses, venoarterial extracorporeal membrane oxygenation (ECMO) was administered, which stabilized the hemodynamic status. Day after, the ultrasound showed left ventricle ejection fraction of 45-50%, and a thickened 26-milimeter septum with hyperechogenic and hypokinetic middle part, possibly attributed to ischemic necrosis. Four days later ECMO was discontinued. On day 32, the patient was discharged from the hospital in a good condition with a normal neurological status, and with implanted automatic cardioverter defibrillator. Three months after the discharge, ultrasound showed a 15-milimeter septal thickness and left ventricle ejection fraction of 62%. Cardioverter defibrillator was not activated after implantation. The patient’s appearance was less muscular than at the time of incident. Although we were not able to prove the presence of anabolic steroids, patient’s muscular appearance and a newly diagnosed heart condition chronologically connected with the gym activities, made us suspect of abuse of anabolic steroids as the cause of hypertrophic cardiomyopathy. A gradual decrease of the septal thickness later may be connected to the abstinence from steroids after the incident, although it also may be attributed to ischemic myocardial necrosis. Synthetic cannabinoids, usually sold as cheap air fresheners, are known to cause cardiac infarction and arrest. They are difficult to prove by laboratory tests. Sources other than the patient and his parents strongly suggested that the patient took those substances just before the cardiac arrest. We presume that there is a significantly greater risk of a life-threatening arrhythmia and/or cardiac arrest in the case of hypertrophic cardiomyopathy if the patient abuses synthetic cannabinoids.
Source: Abstracts
Institution: University Hospital Centre Zagreb
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3205644348