This case report describes a 31-year-old man with 10 years of cocaine and cannabis dependence who developed reverse Takotsubo cardiomyopathy (rTC), a rare variant of Takotsubo cardiomyopathy. He presented to the Emergency Department (ED) with severe left temporal headache and vomiting which began whilst smoking cannabis and several hours after smoking methamphetamine and using cocaine via insufflation. Computed tomography and angiography of the brain was normal, and the headache resolved with analgesia. Urine drug screen was positive for benzodiazepines, cannabinoids, cocaine, opiates (attributed to morphine administered in ED) and amphetamines. Three hours later he had a seizure and within 10 min developed cardiogenic shock with antero-inferior ST segment depression on electrocardiogram and troponin-T rise to 126 ng/L. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram demonstrated severely impaired left ventricular (LV) systolic function with ejection fraction 15–20% and hypokinesis sparing the apex. Thyrotoxicosis, nutritional, vasculitic, autoimmune and viral screens were negative. Cardiac magnetic resonance imaging demonstrated severe LV functional impairment with dilated and hypocontractile basal segments, and T2 hyperintensity consistent with myocardial oedema and rTC. He received supportive management. Proposed mechanisms of rTC include catecholamine cardiotoxicity and coronary artery vasospasm. In this case, multiple insults including severe headache, cannabis hyperemesis and cocaine and methamphetamine-induced serotonin toxicity culminated in a drug-induced seizure which led to catecholamine cardiotoxicity resulting in rTC. Clinicians should be cognizant of stress cardiomyopathy as a differential diagnosis in patients with substance use disorders.

本病例报告描述了一名 31 岁的男性，他有 10 年的可卡因和大麻依赖，他患上了反向 Takotsubo 心肌病 (rTC)，这是一种罕见的 Takotsubo 心肌病变体。他在吸食大麻时开始出现严重的左侧颞叶头痛和呕吐，并在吸食甲基苯丙胺和通过吹入使用可卡因数小时后出现在急诊科 (ED)。计算机断层扫描和脑血管造影正常，镇痛缓解头痛。尿液药物筛查对苯二氮卓类、大麻素、可卡因、阿片类药物（归因于 ED 中使用的吗啡）和安非他明呈阳性。3 小时后癫痫发作，10 分钟内出现心源性休克，心电图显示 ST 段前下压低，肌钙蛋白-T 升高至 126 ng/L。冠状动脉造影显示冠状动脉正常。经胸超声心动图显示左心室 (LV) 收缩功能严重受损，射血分数为 15-20%，心尖部运动功能减退。甲状腺毒症、营养、血管炎、自身免疫和病毒筛查均为阴性。心脏磁共振成像显示严重的左心室功能障碍，伴有扩张和低收缩的基底节，以及与心肌水肿和 rTC 一致的 T2 高信号。他得到了支持性管理。提出的 rTC 机制包括儿茶酚胺心脏毒性和冠状动脉血管痉挛。在这种情况下，包括严重头痛在内的多重侮辱，大麻剧吐以及可卡因和甲基苯丙胺诱导的血清素毒性最终导致药物诱导的癫痫发作，导致儿茶酚胺心脏毒性导致 rTC。临床医生应认识到应激性心肌病可作为物质使用障碍患者的鉴别诊断。