Methamphetamine-associated severe coronary artery ectasia  presenting as ST-elevation myocardial infarction in young adult

Chanokporn Puchongmart; Natnicha Jakramonpreeya; Weerinth Puyati; Ben Thiravetyan

doi:10.12746/swjm.v14i59.1565

Chanokporn Puchongmart Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Natnicha Jakramonpreeya Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
Weerinth Puyati Central Chest Institute of Thailand, Nonthaburi, Thailand
Ben Thiravetyan Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

DOI: https://doi.org/10.12746/swjm.v14i59.1565

Abstract

While cocaine has been reported as a risk factor for coronary artery ectasia (CAE), the effects of other stimulants, such as methamphetamine, on CAE is inadequately described. We present a case of a mid-40s man with a history of hypertension, hyperlipidemia, and methamphetamine abuse who presented with acute-onset chest pain. His electrocardiogram indicated an inferior wall ST-elevation myocardial infarction (STEMI). Coronary angiography revealed diffuse and severe CAE with complete thrombotic occlusion of distal RCA and large thrombus burden in mid-RCA segment. Percutaneous coronary intervention was performed in the distal RCA. However, residual thrombus persisted in the mid-RCA segment. He was later discharged on dual antiplatelet therapy with a plan to initiate anticoagulation in the outpatient setting due to right groin hematoma. Prior studies regarding CAE and methamphetamine are still limited. In addition to his atherosclerotic risk factors, methamphetamine may have also contributed to the development of CAE.

Keywords: Coronary artery ectasia; Methamphetamine; Myocardial infarction

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