Methamphetamine-triggered coronary slow flow: A case report

Abstract

Methamphetamine use is a growing public health concern with significant cardiovascular consequences, including coronary vasospasm, myocardial injury, and arrhythmias. We describe a 38-year-old man with a five-year history of weekly methamphetamine use who presented with chest pain, palpitations, and elevated troponin levels two hours after drug intake. Although his electrocardiogram was non-ischemic, coronary angiography demonstrated normal epicardial arteries with coronary slow flow, most pronounced in the left anterior descending artery. Despite the absence of obstructive disease, the clinical and laboratory findings were consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The corrected TIMI frame count confirmed diffuse slow flow, and a toxicology screen was positive for methamphetamine. The patient was treated with diltiazem, aspirin, and statin therapy, and was discharged in stable condition after 72 hours. At three-month follow-up, he remained symptom-free and abstinent from methamphetamine. This case highlights the uncommon coexistence of MINOCA and coronary slow flow related to methamphetamine use, suggesting a central role of microvascular dysfunction and coronary vasoreactivity. Routine toxicology screening should be considered in young patients with atypical myocardial infarction presentations to better understand and manage substance-related coronary pathophysiology.

Keywords

• Methamphetamine
• coronary slow flow
• MINOCA

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