Ketamine induced acute systolic heart failure
  • Fares Saliba
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Jonathan Mina
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Laurence Aoun
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Georges Khattar
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Elie Bou Sanayeh
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Jennifer Jdaidani
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA
  • Ibrahim Al Saidi
    Department of Internal Medicine, Staten Island University Hospital, Staten Island, USA

Keywords

Ketamine, heart failure, ketamine-induced disorder, systolic heart failure

Abstract

Background: Studies have shown major cardiovascular effects associated with ketamine use disorder including dose-dependent negative inotropic effects. Preoperative ketamine use has been linked to ketamine-induced stress cardiomyopathy.
Case presentation: A 28-year-old female with a history of recurrent cystitis and ketamine use disorder (twice weekly for 14 years) presented with bilateral lower extremity oedema and shortness of breath for 3 months. She was tachycardic with a troponin level of 0.07 ng/ml and a B-type natriuretic peptide (BNP) level of 2511 pg/ml. Electrocardiogram showed normal sinus rhythm and transthoracic echocardiography (TTE) showed left ventricular ejection fraction (EF) of 15%, dilated left ventricle, and severe tricuspid and mitral regurgitation. Computed tomography (CT) scan of the chest and abdomen showed bilateral pleural effusions with congestive hepatopathy and ascites. The patient was started on intravenous furosemide, metoprolol, and sacubitril/valsartan. Rheumatological workup including complement levels, and antinuclear anti-double-stranded DNA was negative. A repeat TTE 2 weeks later revealed an EF of 25% and moderate tricuspid regurgitation. Four months later, the EF was 54% with normal left ventricular cavity size.
Conclusion: Although ketamine use disorder is increasing, data on long-term side effects is minimal. Screening for ketamine use disorders should be considered in patients presenting with acute systolic heart failure. Long-term studies are needed to evaluate the benefits of adding ketamine screening to standard urine toxicology.

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    Published: 2024-04-23
    Issue: 2024: Vol 11 No 6 (view)


    How to cite:
    1.
    Saliba F, Mina J, Aoun L, Khattar G, Bou Sanayeh E, Jdaidani J, Al Saidi I. Ketamine induced acute systolic heart failure. EJCRIM 2024;11 doi:10.12890/2024_004470.

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