Source: Revista Colombiana de Cardiología

Heroin-induced myocardial infarction

Beatriz Wills, Andrés F. Buitrago, Nohra P. Romero, Mariana Soto

Received 17 September 2013
Accepted 10 March 2014
Available online 24 September 2014

Due to signs of opioid intoxication and imminence of respiratory failure, airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain of moderate to severe intensity, without dysautonomia or dyspnea. Faced with the possibility of acute coronary syndrome, a troponin I test was requested initially resulting in 0.48 ng/ml (reference value= 0-0.3 ng/ml). The initial electrocardiogram revealed ST segment elevation in the anterolateral part of the face (Fig. 2). The electrocardiogram results ruled out abnormalities. Given the clinical and biochemical findings, acute myocardial infarction of Type II ST segment elevation, Killip-Kimball I, was diagnosed, for which the use vasodilator with low doses of intravenous nitroglycerin, dual antiplatelet therapy (clopidogrel and aspirin), and full anticoagulation with low molecular weight heparin were initiated.

Revista Colombiana de Cardiología

www.elsevier.es/revcolcar

ADULT CARDIOLOGY – CASE PRESENTATION

Heroin-Induced Myocardial Infarction

Beatriz Wills[a] *, Andrés F. Buitrago[b]a,b,*, Nohra P. Romeroa,b y Mariana Soto 

[a] Department of Critical Medicine and Intensive Care, Foundation Santa Fe de Bogotá University Hospital, Bogotá, Colombia

[b] Department of Internal Medicine, Cardiology Section, Foundation Santa Fe de Bogotá University Hospital, Bogotá, Colombia

*Author for correspondence

Email: [email protected] (A.F. Buitrago)

Received September 17, 2013; accepted March 10, 2014

Available online by September 24, 2014

Due to signs of opioid intoxication and the imminence of respiratory failure, airway support and naloxone treatment were initiated. During emergency care the patient indicated localized precordial pain, of moderate intensity, without dyspnea. In view of possible acute coronary syndrome, the patient was administered troponin I, which it’s initial result was 0.48 ng/ml (reference value: 0-0.3 ng/ml). The initial echocardiogram revealed supra-uneven ST anterolateral face (fig. 2). The echocardiogram results dismissed abnormalities. According to the clinical and biochemical findings, the patient was diagnosed acute myocardial infarction with elevation on the ST type 2, Killip Kimball I. Therefore, low doses of vasodilation with nitroglycerin through IV, dual anti-aggregation therapy (Clopidogrel and aspirin), and full anticoagulation with heparin of low molecular mass were initiated.

EL SERVIER DOYMA

Revista Colombiana de Cardiología (Colombian Magazine of Cardiology)

www.elservier.es/revcolcar

Adult Cardiology – Case Studies

Heroin-induced myocardial infarction

Beatriz Willsª, Andrés F. Buitragoªb*, Nohra P. Romeroªb y Mariana Sotoª

ª Department of Critical Care Medicine and Intensive Care, University Hospital Fundación (Foundation) Santa Fe de Bogotá, Bogotá, Colombia

b Department of Internal Medicine, Section of Cardiology, University Hospital Fundación (Foundation) Santa Fe de Bogotá, Bogotá, Colombia

Received September 17, 2013; accepted March 10, 2014

Available online on September 24, 2014

…Due to signs of opioid intoxication and the imminence of respiratory failure, airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain, of modern intensity, without dysautonomia or dyspnea. Given the possibility of acute coronary syndrome, troponin I was requested, with an initial result of 0.48 ng / mL (reference value: 0-0.3 ng / ml). The initial electrocardiogram showed an ST irregularity in the anterolateral side (fig. 2). An echocardiogram revealed no abnormalities. Given the clinical and biochemical findings, acute myocardial infarction with ST elevation type 2 Killip-Kimball 1 was diagnosed. Vasodilator care was initiated with low-dose intravenous nitroglycerin at low doses, dual antiplatelet therapy (clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin.

Heroin-induced myocardial infarction

Beatriz Wills, Andrés F. Buitrago, Nohra P. Romero and Mariana Soto

 Received on September 17, 2013; accepted on March 10, 2014

Available online on September 24, 2014

Due to signs of opioid intoxication and imminence of respiratory failure, airway and naloxone treatment were initiated. During emergency care the patient indicated localized precordial pain without dysautonomia or dyspnea. Given the possibility of acute coronary syndrome, we requested troponin I, which initial result was 0.48 ng/ml (reference value: 0- 0.3 ng/ml). The initial electrocardiogram showed upsloping ST elevation on the front anterolateral (fig. 2). The result of the Echocardiogram ruled out abnormalities. Due to clinical and biochemical findings, the patient was diagnosed with acute myocardial infarction with ST-Elevation type 2, Killip-Kimball I, therefore low doses of vasodilator with intravenous nitroglycerin, anti dual aggregation (clopidogrel and aspirin) and full anticoagulation with heparin of low weight molecular were administered on the patient.

Revista Colombiana de Cardiología

ADULT CARDIOLOGY — CASE STUDIES

Heroin-Induced Acute Myocardial Infarction

 Beatriz Wills (a), Andrés F. Buitrago (a, b), Nohra P. Romero (a,b) and Mariana Soto (a)

 (a) Department of Intensive and Critical Care Medicine, Hospital Universitario Fundación Santa de Fe de Bogotá, Bogotá, Colombia

(b) Department of Internal Medicine, Cardiology Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

Received September 17, 2013; accepted March 10, 2014. Web publication September 24, 2014.

…Due to signs of opioid overdose and imminent respiratory failure, airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain of moderate intensity, with no dysautonomia or dyspnea. Given the possibility of acute coronary syndrome, troponin I was requested, with an initial result of 0.48 ng/ml (reference value: 0-0.3 ng/ml). The initial electrocardiogram showed ST segment elevation in the anterolateral leads (fig. 2). An echocardiogram revealed no abnormalities. Given the clinical and biochemical findings, type 2 acute MI with ST segment elevation, Killip-Kimball I, was diagnosed. Vasodilator treatment was initiated with low-dose intravenous nitroglycerin, dual antiplatelet therapy (Clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin.

Colombian Cardiology Magazine

www.elsevier.es/revcolcar

Heroin induced myocardial infarction

Adult Cardiology – Case Studies

Due to signs of opioid intoxication and imminence respiratory failure, airway support and naloxone treatment were initiated. During emergency care patient indicated localized precordial pain of moderate intensity, without dysautonomia or dyspnea. In light of the possibility of possibility acute coronary syndrome, troponin, -i, initial result was 0.48 ng / ml (reference value: 0-0.3 ng / ml). The initial electrocardiogram showed elevation ST elevation front anterolateral (fig. 2). The result of the echocardiogram ruled out abnormalities. Due the clinical and biochemical findings, infarction was diagnosed with acute ST elevation myocardial type 2, Killip- Kimball I, whereby intravenous vasodilator management connitroglicerina started at low doses, dual antiplatelet therapy (clopidogrel and aspirin) and full anticoagulation with heparin low molecular weight.