P0627 - A Case for Advancing Pediatric Addiction Medicine: Methamphetamine-associated Congestive Heart Failure in a 27 year old patient

Introduction
Heart failure has been estimated to affect roughly 5.7 million within the United States and 26 million worldwide (1). Though there are myriad causes of this condition, methamphetamine-associated heart failure (MethHF) is showing an increase in prevalence (2). MethHF has more recently been demonstrated to appear in relatively younger patients when compared to non-methamphetamine associated heart failure (non-MethHF) patients, with the median age of 49.7 for the former compared to median age of 74.2 for the latter. Yet, there are limited reports of MethHF appearing within very young populations. This case report discusses that of a 27 year old male diagnosed with MethHF.
Case Description
A 27 year old male presented to the emergency department with one week of shortness of breath, orthopnea, and pleuritic chest pain. Chest radiography showed cardiomegaly with mild central vascular congestion. Due to his initial symptoms, a CT pulmonary angiography was obtained and was negative for pulmonary embolism though it did show small right pleural effusion, moderate pulmonary edema, and cardiomegaly. ECG showed left ventricular hypertrophy with sinus tachycardia. BNP was 3,016 and transthoracic echo showed an ejection fraction of 17%, severe global hypokinesis of the left ventricle with severely reduced systolic dysfunction and restrictive diastolic dysfunction suggestive of decreased left ventricular diastolic compliance and/or increased left atrial pressure. Systolic function of the right ventricle was also moderately to severely reduced. This patient had last used methamphetamine 4 days prior to arrival and had, per further history, regular use of methamphetamines since he was 13 years old.
Discussion
Substance abuse within pediatric patients has been discussed because of the physiological, social, and behavioral influences that this use can cause (3,4). However, there are limited reports of methamphetamine use and heart failure within pediatric patients. This case highlights the importance of intensified pediatric addiction medicine techniques given that this patient’s persistent use at an early age led to such severe cardiac changes that his presenting diagnosis was advanced heart failure.
Conclusion
Early interventions should be devised within pediatric populations to appropriately tackle issues of addiction and prevent advanced co-morbidities.